Method of preservation is not a determinant of graft outcome in kidneys transplanted by Southeastern Organ Procurement Foundation Institutions.

We report the observation that the major sources of variation in cadaver renal allograft survival rates are not related to the technique of donor organ preservation but are related solely to other factors including pretransplant blood transfusion of the recipient, antilymphocyte serum (ALS) treatment of the recipient, and high HLA match. In contrast to prior studies which used univariate methods to analyze similar data, our analysis shows that it is imperative that comparisons of different methods of cadaver preservation must include adjustments for the effects of pretransplant blood transfusions, antilymphocyte serum, and HLA match.

Increasing the supply of cadaveric kidneys for transplantation.

The number of cadaveric kidneys currently available for transplantation is insufficient. Therefore, the Center for Disease Control (CDC) undertook a collaborative project with the two transplant programs in Georgia to increase te retrieval of cadaveric kidneys. We used retrospective analysis to select productive hospitals, hospital-specific surveillance systems to identify potential donors, and procurement and retrieval evaluation to identify preventable deficiencies. During 900 hospital months of prospective surveillance, we identified a total of 555 potential donors by death record review, giving a potential donor rate of 2.3 donors/100 deaths (110 kidneys/million population/year). We observed an increase in the number of referrals, consent obtained from next of kin, and kidneys retrieved. This period of intensive activity demonstrated that additional kidneys can be retrieved by using systematic methods.

Elevated basilic vein arteriovenous fistula.

BACKGROUND: Many surgeons continue to use prosthetic arteriovenous grafts for dialysis access despite the clear superiority of native arteriovenous fistulas. This study was undertaken to review our experience with elevated brachial-basilic fistulas as an alternative to prosthetic grafts in patients lacking veins suitable for more conventional arteriovenous fistulas. METHODS: We retrospectively reviewed the outcomes of 67 patients receiving elevated brachial-basilic arteriovenous fistulas over a 10-year period. Operative complications and causes of failure were identified and actuarial fistula patency determined. RESULTS: No patients suffered wound infections, and only 1 developed a steal syndrome in the late postoperative period. Actuarial fistula patency was 84% at 1 year, 73% at 3 and 5 years, and 52% at 10 years. CONCLUSIONS: The elevated brachial-basilic arteriovenous fistula is a superb alternative to prosthetic arteriovenous grafts in patients lacking suitable cephalic veins for native arteriovenous fistulas. Operative complications are uncommon, vascular steal is rare, and long-term patency is excellent.

72 kidney transplants at the Medical College of Georgia 1968-1976.

Seventy-two kidneys have been transplanted-47 from related donors, and 25 from cadaver donors-into 63 recipients. No donor died or experienced a complication requiring more than one extra week of hospitalization. Six recipients died. Three of the six recipients died from complications. Two of the six died only because they declined to resume hemodialysis, and one died in prison of unusual circumstances after seven and one-half years of good health and kidney function. Five patients are surviving by virtue of a second transplant. Eight patients are now on hemodialysis. Seven patients with transplants are not in excellent physical health and five other patients with excellent health and renal function are nonetheless frequently depressed and easily upset over minor physical disabilities. A majority of the recipients have been rehabilitated to a gratifying extent.

In situ dissection of cadaver kidneys.

Major anatomic injuries occurred in 18 of 151 (12%) en bloc kidneys. No injuries occurred among the in situ kidneys. The rates of delayed graft function were equal. All the kidneys removed by the in situ method were removed by one surgeon (ALH). The results are good enough to recommend the technique even without a randomized study.

Hemodialysis access: elevated basilic vein arteriovenous fistula.

Vascular access in the pediatric patient with endstage renal disease (ESRD) can be a surgical challenge to perform as well as maintain. We have recently developed a new technique of elevating the basilic vein in the upper arm for the arteriovenous (AV) fistula instead of using a polytetrafluoroethylene (PTFE) graft. During the past 2 years, 66 patients with ESRD and unsuitable superficial veins have had basilic vein elevation. Of these 66 patients, four have been in children, aged 11 to 19 years. The technique of mobilization of the vein from the elbow to the axilla was similar to that described by Dagher et al except that we used one long incision. The new feature of this technique is that the vein is not rerouted laterally through a subdermal tunnel. Instead, after the AV fistula to the side of the brachial artery is created, the vein is elevated within the incision by closing the subcutaneous fascia beneath, and the skin over, the vein. Most veins could be used in 2 to 4 weeks. Of the entire group, the patency rate has been 55 of 66 (83.3%), with no infections or long-term morbidity. Of the four pediatric patients, there have been no thromboses or infections. We believe the operation to be easier to perform than the standard PTFE bridge graft. The subsequent AV fistula is easy to access, less likely to cause a "steal syndrome," less likely to become infected, and if it does become infected, more likely to respond to treatment with antibiotics.

Living-related kidney donation.

Living renal donation is an effective means to expand the organ donor pool and allow more transplants to be performed at greater convenience for the recipient and with greater long-term success. Risks to the recipient appear to be minimal as long as careful donor screening is employed. Living donation has been implemented in extra-renal transplantation more recently. While the experience is limited so far, living donation is likely to remain an important option for liver and lung recipients.

Ureteroneocystostomy in renal transplantation: a simple transvesical technique.

A simple transvesical technique for transplant ureteroneocystostomy is described. The method has been used in 245 transplants during a 6-year period. Only 4 significant complications (1.6 per cent) were recognized and no kidney was lost owing to a complication of ureteroneocystostomy.