Partial bladder transplantation with en bloc kidney transplant-long-term, 17 years, the outcome of a "bladder patch technique".

A transplant of a portion of the bladder with an en bloc kidney from a 2-year-old donor was previously reported in a 12-month-old girl due to her extremely small bladder. Bilateral kidneys were transplanted en bloc with their ureters connected to a patch of the donor bladder (bladder patch technique). The long-term outcomes and complications of this technique have not been documented. Here, we report a long-term, 17-year follow-up of this patient with an evaluation of whole bladder functions at 18 years of age. The patient has had no episodes of urinary tract infections. Cystoscopy showed a viable transplanted bladder with a well-perfused mucosa. We observed that the native bladder has stretched over time, forming more than half of the bladder wall. Urodynamic studies showed preserved bladder compliance at 43 mL/cmH2O, and native bladder contractility was preserved. Prolonged voiding time and postvoid residual urine were also observed. These findings were suggestive of detrusor underactivity. No reflux across the donor ureterovesical junctions was observed. The recipient was instructed to continue timed voiding and double voiding to empty the bladder. In conclusion, en bloc kidney transplantation with a bladder patch is a feasible and safe option for kidney transplant recipients with a small bladder capacity.

Technical Feasibility of Renal Artery Embolization on a Transplanted Kidney Due to Intractable Unilateral Hydronephrosis After En Bloc Kidney Transplantation: Case Report.

INTRODUCTION: En bloc kidney transplantation (EBKT) is a technique used to transplant pediatric kidneys to adult recipients, but can lead to certain complications seldom found in single-kidney transplantation. We report a case of renal artery embolization after EBKT due to intractable unilateral hydronephrosis and highlight the technical details and challenges of the procedure. CASE: An 18-year-old female with MELAS syndrome underwent EBKT from a 10-month-old male baby. Two months later, the patient developed unilateral hydronephrosis and recurrent urinary tract infections, which was intractable to conventional therapy. Therefore, we underwent embolization of the problematic transplanted left kidney. Owing to the complicated anatomy and multiple angulations, multiple microcatheters, wires and support catheters were needed to select the renal arteries. Repeated procedures were required due to remnant flow from small branches and accessory renal arteries that were not easily visualized by conventional angiography, which were eventually detected by adjunctive use of 3-dimensional rotational angiography. CONCLUSIONS: Selective renal artery embolization after EBKT is challenging due to the short renal artery length and multiple angulations, yet it can still be performed safely and effectively by use of meticulous catheter-wire interactions and adjunctive intraoperative imaging techniques to delineate the precise anatomy of the target arteries. CLINICAL IMPACT: Selective renal artery embolization, which is less invasive than nephrectomy, can be considered if the culprit kidney must inevitably be sacrificed in en bloc kidney transplantation.

En bloc kidney transplantation from infant donors younger than 10 months into pediatric recipients.

Early graft loss and poor graft function limit the use of kidneys from infant donors. Six en bloc kidney transplantations were performed from infant donors younger than 10 months into pediatric recipients between November 2012 and September 2015 at our center. We retrospectively analyzed recipient and donor demographics, surgery procedures, complications, graft function and size, and patient and graft survival with a follow-up of 6-39 months (median 15.5 months). Donor age ranged from 1 to 10 months with weight ranging from 3.5 to 10 kg. Recipient age ranged from 10 to 16 years with weight ranging from 30 to 39 kg. One kidney was removed due to arterial thrombosis during surgery, while the other kidney of this en bloc graft remained viable. Urine leak followed by bilateral ureteral obstruction occurred in one recipient. All of the recipients showed immediate graft function. The size of the en bloc kidney increased from 4.2±0.6 cm to 7.6±0.6 cm 6 months after surgery. Patient and graft survival were both 100% at the last follow-up. Our results show that en bloc kidney transplantation from infant donors younger than 10 months into pediatric recipients is effective under the condition of experienced surgical techniques and perioperative management.

En Bloc Kidney Transplantation: A Retrospective Study of an 18-year Experience in a Single Institution.

Background: Renal transplantation is facing a shortage of grafts. En bloc kidney transplantation (EBKT) from pediatric donors could increase the number of available grafts. Objective: To describe the surgical technique as well as the long-term functional and morphological results of EBKT. Design setting and participants: We performed a retrospective study of all the EBKT procedures performed in Lyon between 2002 and 2020. Electronic medical records were checked with an analysis of demographics, and peri- and postoperative results. Outcome measurements and statistical analysis: A descriptive analysis of donor and recipient characteristics, perioperative data, complications, and renal function was performed. Results and limitations: Between 2002 and 2020, 21 EBKT procedures were performed. Donors had a mean weight of 8.6 kg and a mean age of 12 mo, with a mean cold ischemia time of 11 h and 30 min. Receivers had a mean age of 30 yr and a body mass index of 20. The mean follow-up time was 62 mo, with patient survival of 100% and graft survival of 95%. There were 13 reinterventions comprising one early unilateral transplantectomy for thrombosis. Renal function was excellent, and the morphological findings described an important growth in size in the first 2 yr before attaining the adult size. This study's limitations include its retrospective nature and a small number of participants. Conclusions: The present study reports excellent results with EBKT and supports the pursuit and spread of this technique. Patient summary: In this report, we describe the technique and results of en bloc kidney transplantation. We found that results are excellent for renal function and patient survival. We conclude that en bloc kidney transplantation should be considered to increase the number of grafts.

En bloc kidney transplantation from a 24 month-old donor to an adult recipient: case presentation and literature review.

Paediatric kidney transplantation into adult recipients is a well-recognised technique. However, there are different opinions regarding two methods of transplantation. These two opinions are single kidney transplantation (SKT) and en bloc kidney transplantation (EBKT) from donors up to 20 kg. We are reporting the first successful en bloc kidney transplantation from a small, paediatric donor into an adult recipient in our institution and discussing the appropriate recent literature regarding possible concerns using this technique. Despite the fact that paediatric donors are uncommon and surgical experiences are limited, en bloc kidney transplantation can be performed successfully and could be used to expand the donor pool.

En bloc transplantation of horseshoe kidney in Korea.

Transplantation of the horseshoe kidney can be performed en bloc or split into 2 grafts according to the vascular anomaly and the existence of the urinary collecting system in isthmus. From 2011 to 2014, there were 3 horseshoe kidney transplantations in Korea and transplantations were performed at 2 different centers. The transplantations were carried out successfully for all recipients without complications. All recipients have shown good graft kidney function after transplantation. No severe complication was revealed during follow-up period. We described the surgical technique used in the en bloc method to overcome various vascular anomalies and difficulties in choosing cannulation site and postoperative complications. En bloc transplantation of a horseshoe kidney is a useful strategy for patients with end-stage renal disease, and can provide favorable outcomes compared to the transplantation of a normal kidney.

Trasplante renal en bloque: a propósito de un caso / En bloc kidney transplantation: case report

En México la enfermedad renal crónica en la población pediátrica es un grave problema de salud pública. Las alternativas terapéuticas en niños con enfermedad renal crónica (ERC) son la diálisis y el trasplante renal (TxR), siendo esta última, la mejor opción terapéutica actual en niños con estadios terminal de la función renal. El objetivo de este manuscrito, fue reportar nuestra experiencia en el tratamiento perioperatorio de pacientes pediátricos sometidos a trasplante renal en bloque. Paciente de sexo femenino, 12 años de edad, originaria de Veracruz, México. Portadora de ERC estadio IV de KDOQI, secundaria a glomerulopatía. Fue programada para TxR en bloque de donante cadavérico pediátrico; el que se realizó bajo anestesia general balanceada, con ventilación mecánica controlada, isquemia fría de 17 hs, isquemia caliente de 30 min y un tiempo quirúrgico de 5 hs y 10 min. El tiempo anestésico total, fue de 6 hs. La paciente fue trasladada a la Unidad de Terapia Intensiva Pediátrica, con adecuada aceptación del injerto renal. Durante los siguientes siete meses, el curso clínico ha sido satisfactorio, con estudios ecotomográficos renales normales. En esta paciente la glomerulonefritis, le ocasionó que debutara a muy corta edad con una enfermedad renal crónica con terapia sustitutiva de hemodiálisis. El trasplante renal en bloque realizado, fue exitoso debido al manejo multidisciplinario que participa en el programa de trasplante renal

In Mexico, chronic kidney disease is a major public health problem in pediatric patients. The therapeutic options for chronic kidney disease (CKD) in children are dialysis and kidney transplant (KT); the latter constitutes the current treatment of choice for children suffering from end-stage renal disease. The aim of this study was to describe our experience of perioperative treatment of pediatric patients undergoing en bloc kidney transplant. Female patient, 12 years old, from Veracruz, Mexico, suffering from stage 4 CKD according to KDOQI criteria, secondary to glomerulonephritis. An en bloc kidney transplantarion from a pediatric deceased donor was performed; balanced general anesthesia with mechanical ventilation was used. Cold ischemia time was 17 hours and warm ischemia time was 30 minutes. The surgery lasted 5 hours and 10 minutes and the total anesthesia time was 6 hours. The patient was taken to the pediatric intensive care unit and showed an adequate renal graft acceptance. During the following seven months the clinical course was satisfactory and kidney echotomography showed normal results. Glomerulonephritis made this patient undergo hemodialysis replacement therapy due to CKD at a very early age. The en bloc kidney transplantation performed was successful thanks to the multidisciplinary management involved in the Kidney Transplant Program

En bloc transplantation of horseshoe kidney in Korea

Transplantation of the horseshoe kidney can be performed en bloc or split into 2 grafts according to the vascular anomaly and the existence of the urinary collecting system in isthmus. From 2011 to 2014, there were 3 horseshoe kidney transplantations in Korea and transplantations were performed at 2 different centers. The transplantations were carried out successfully for all recipients without complications. All recipients have shown good graft kidney function after transplantation. No severe complication was revealed during follow-up period. We described the surgical technique used in the en bloc method to overcome various vascular anomalies and difficulties in choosing cannulation site and postoperative complications. En bloc transplantation of a horseshoe kidney is a useful strategy for patients with end-stage renal disease, and can provide favorable outcomes compared to the transplantation of a normal kidney.

Clinical efficacy of en-bloc kidney transplantation from pediatric donor kidneys / 器官移植

Objective To evaluate the clinical efficacy of en-bloc kidney transplantation from pediatric organ donation after death. Methods Clinical data of donors and recipients undergoing en-bloc kidney transplantation from pediatric donor kidneys were retrospectively analyzed. The 1-year survival rates of the recipient and grafted kidney were calculated. The recovery of renal function at postoperative 1 year was observed. The changes in the length of grafted kidney and incidence of postoperative adverse events were monitored. Results The 1-year survival rate of the recipients was 8/9, and 72% for the grafted kidney. During 1-year follow-up, the serum creatinine (Scr) level was down-regulated from (747± 170) μmol/L before transplantation to (83±27) μmol/L post-transplantation, the blood urea nitrogen concentration was decreased from (24.5±4.9) mmol/L to (6.8±2.0) mmol/L, and the length of transplanted kidney was increased from (61.1±9.8) mm to (100.3±1.7) mm. Two recipients suffered from delayed graft function(DGF) and restored after hemodialysis. Two cases developed acute rejection and healed after methylprednisolone shock therapy. One recipient presented with lung fungal infection at postoperative 2 weeks after transplantation, and was treated by the withdrawal of immunosuppressive agents and antibacterial treatment with poor clinical efficacy. Then the recipient died at 3rd month. One case had renal arterial thrombosis at postoperative 7 d, underwent nephrectomy at postoperative 10 d and returned to hemodialysis. At postoperative 1st month, one recipient suffered from thrombosis of unilateral renal artery. The grafted kidney in other side normally functioned and significantly grew in size at postoperative 6 months. In addition, two cases had ureterostenosis of the transplanted kidney, albuminuria in 2, abdominal aortic stenosis in 1 and urinary fistula in 1. All these symptoms were cured or alleviated after corresponding treatment. Conclusions The incidence of perioperative complications is relatively high in en-bloc kidney transplantation from pediatric organ donation after death, whereas the clinical efficacy of such kidney transplantation can be gradually increased along with the accumulation of clinical experience.

Clinical efficacy of en-bloc kidney transplantation from infantile donor organs to adult recipients:report of two cases / 器官移植

Objective To evaluate the clinical efficacy of en-bloc kidney transplantation from infantile organ donation after citizen's death to adult recipients. Methods Clinical data, surgical approach, use of immunosuppressive agents and follow-up of two adults undergoing kidney transplantation from infantile donor organs were retrospectively analyzed. Relevant literature review was performed. Results One male recipient was diagnosed with primary diseases of chronic renal lesions and renal failure. After kidney transplantation, the recipient obtained favorable recovery of kidney function. The grafted kidney was gradually increased in size. During the final follow-up (10 months after surgery), the serum creatinine level was measured as 84 μmol/L. The other female recipient was diagnosed with renal failure accompanied with uremia. The recipient died from heart failure complicated with severe pulmonary infection at postoperative 23 d. No vascular complications occurred in either recipient. Conclusions Kidney transplantation from infantile donor organs to adult recipients yields favorable clinical efficacy and the grafted kidney is significantly increased in size during the early stage. Precise intraoperative manipulation contributes to preventing the incidence of arterial embolism of the donor kidney and other postoperative complications.