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07 A prospective randomized study of early versus late removal of dj stents after renal transplants and its outcome
150 Indian Journal of Transplantation 2011 July–September (Supplement); Vol. 5, No. 3 Abstr
2010 started on continuous peritoneal dialysis. He presented to us for renal transplant in October 2010. Results: During transplant evaluation, patient’s weight was 11.3 kg with a height of 89 cm, body mass index—14.26. On cystogram, no reflux and could not void. Cystoscopy revealed no residual valve with smooth bladder wall. On urodynamic monitoring, bladder capacity of 190 mL but could not void with pVes of 87 cmH2O. His father came forward as the donor; with left kidney of size 9.4 cm with a single vessel was accepted. He underwent extraperitoneal right iliac fossa renal transplant on 21/12/2010. Anastomosis was done with common iliac vessel and SPC was kept. Then best s.creatinine was 0.23. After 3 weeks, he was operated for left ureteostomy as mitrofanoff and CAPD removal. At 9 months follow-up, serum creatinine is 0.3 and comfortable with clean intermittent catheterization. Conclusion: Extraperitoneal renal transplantation is technically feasible in children who weigh < 12 kg. This approach preserves the peritoneal cavity, and limits potential gastrointestinal complication.
07 doi: 10.1016/S2212-0017(11)60011-7 A prospective randomized study of early versus late removal of dj stents after renal transplants and its outcome B Lenin, P Ghosh, M Suryavanshi, S Gogoi, R Khera, G Gautam, R Ahlawat Department of Nephrology, Medanta Hospital, Gurgaon, India
Introduction: DJ stents have reduced urinary complications from 9% to 1.5% in unstented patients. With over 1000 renal transplants done, no ureteric leak or anastomotic stricture were observed when stents were removed after 3 weeks but stents have been criticized for UTI and Pyelonephritis (incidence 8%). Aim and objectives: To see the feasibility of early stent removal in an attempt to reduce pyelonephritis episodes but retaining advantages of DJ stenting. Materials and methods: Patients who underwent kidney transplantation at a tertiary care hospital by a single team from April 2010 to January 2011 were enrolled. Patients were randomized to early (7 days) or routine (21 days) DJ stent removal after kidney transplantation. A standard Lich-Gregoir ureteroneocystostomy was performed in both the groups. The patients were evaluated for graft outcome and infective episodes. Results: Patients fulfilled the randomized criteria (early removal n = 18; routine removal n = 18). Both groups were comparable in terms of age, sex, ischemia time, number of renal arteries and time to diuresis. No patients had UTI during the first month post-transplant. 2 out of 18 patients with stents removed at 1 week (P < 0.05) had raised creatinine next day due uretero-vesical junction edema causing obstruction. Renal functions normalized when 1 patient underwent re-stenting and other required graft per cutaneous nephrostomy and re-stenting later on. Both patients required prolonged DJ stents (4 weeks). The study was abandoned due to ureteric complication with early removal.
acts
Conclusion: No incidence of UTI noted amongst the two groups. High incidence of ureteric complications were noted when stents were removed at 1 week.
08 doi: 10.1016/S2212-0017(11)60012-9 A case of early TRAS managed with PTRA Noble Gracious, Safeer, Jose Thomas, Sajeev Kumar, Mohandas, Gomathy, Jacob George, Ramdas Pisharody, AK Gupta Department of Nephrology, Medical College, Thiruvananthapuram, India
Transplant renal artery stenosis (TRAS) is a potentially curable cause of post-transplant arterial hypertension, allograft dysfunction and graft loss. It usually occurs 3 months to 2 years after transplantation. Anastomotic site stenosis, in a recent transplant is conventionally managed with surgery and reanastomosis. Here, we report a case of TRAS very close to anastomotic site. 21-year-old boy who underwent live-related donor transplantation, developed graft dysfunction and accelerated hypertension on the 8th postoperative day. He was managed successfully with percutaneous transluminal renal angioplasty (PTRA) on the 19th postoperative day after which there was excellent improvement in graft function as well as hypertension. We report this case because this could be one of the few cases of early Anastomotic site TRAS managed successfully with PTRA rather than surgery.
09 doi: 10.1016/S2212-0017(11)60013-0 Tacrolimus-induced neurotoxicity Ajay Marwaha, Ravi Angral, SPS Subhramanian, A Khullar, T Kataria, RS Chahal Kidney Hospital and Lifeline, Jalandhar, Punjab, India
Introduction: Tacrolimus (FK506) is an effective immunosuppressive agent for the prevention of organ transplant rejection. Neurological complications of tacrolimus therapy that have been reported are usually mild, i.e., tremors, paraesthesia but occasionally severe, i.e., aphasia, ataxia, confusion, seizures. We observed an unusual case of severe encephalopathy which occurred after 24 hours of renal transplantation in the absence of metabolic abnormalities and neurological diseases. Materials and methods: 42 years male; Basic Disease: CGN/ESRD/ HCV +ve. He underwent renal transplantation on July 2011. The donor was his wife. He was started on Triple Immunosuppressant’s: Tacrolimus, Mycophenolate mofetil and Prednisolone. 1 g solumedrol was given at the time of induction. Tacrolimus was started at the dose of 11 mg/day (2 mg/kg body wt.). Postoperatively, he was having good diuresis and his Sr. Creat came down from 2.5 to 0.9, and Sr. Electrolytes were within normal limits. After 24 hours of surgery, patient started c/o headache, irritability, irrelevant talks. Neurological consult was taken and he was diagnosed as having acute delirium state and he was advised CT Head and CSF study. Thinking of the possibility of steroid-induced psychosis and
2010 started on continuous peritoneal dialysis. He presented to us for renal transplant in October 2010. Results: During transplant evaluation, patient’s weight was 11.3 kg with a height of 89 cm, body mass index—14.26. On cystogram, no reflux and could not void. Cystoscopy revealed no residual valve with smooth bladder wall. On urodynamic monitoring, bladder capacity of 190 mL but could not void with pVes of 87 cmH2O. His father came forward as the donor; with left kidney of size 9.4 cm with a single vessel was accepted. He underwent extraperitoneal right iliac fossa renal transplant on 21/12/2010. Anastomosis was done with common iliac vessel and SPC was kept. Then best s.creatinine was 0.23. After 3 weeks, he was operated for left ureteostomy as mitrofanoff and CAPD removal. At 9 months follow-up, serum creatinine is 0.3 and comfortable with clean intermittent catheterization. Conclusion: Extraperitoneal renal transplantation is technically feasible in children who weigh < 12 kg. This approach preserves the peritoneal cavity, and limits potential gastrointestinal complication.
07 doi: 10.1016/S2212-0017(11)60011-7 A prospective randomized study of early versus late removal of dj stents after renal transplants and its outcome B Lenin, P Ghosh, M Suryavanshi, S Gogoi, R Khera, G Gautam, R Ahlawat Department of Nephrology, Medanta Hospital, Gurgaon, India
Introduction: DJ stents have reduced urinary complications from 9% to 1.5% in unstented patients. With over 1000 renal transplants done, no ureteric leak or anastomotic stricture were observed when stents were removed after 3 weeks but stents have been criticized for UTI and Pyelonephritis (incidence 8%). Aim and objectives: To see the feasibility of early stent removal in an attempt to reduce pyelonephritis episodes but retaining advantages of DJ stenting. Materials and methods: Patients who underwent kidney transplantation at a tertiary care hospital by a single team from April 2010 to January 2011 were enrolled. Patients were randomized to early (7 days) or routine (21 days) DJ stent removal after kidney transplantation. A standard Lich-Gregoir ureteroneocystostomy was performed in both the groups. The patients were evaluated for graft outcome and infective episodes. Results: Patients fulfilled the randomized criteria (early removal n = 18; routine removal n = 18). Both groups were comparable in terms of age, sex, ischemia time, number of renal arteries and time to diuresis. No patients had UTI during the first month post-transplant. 2 out of 18 patients with stents removed at 1 week (P < 0.05) had raised creatinine next day due uretero-vesical junction edema causing obstruction. Renal functions normalized when 1 patient underwent re-stenting and other required graft per cutaneous nephrostomy and re-stenting later on. Both patients required prolonged DJ stents (4 weeks). The study was abandoned due to ureteric complication with early removal.
acts
Conclusion: No incidence of UTI noted amongst the two groups. High incidence of ureteric complications were noted when stents were removed at 1 week.
08 doi: 10.1016/S2212-0017(11)60012-9 A case of early TRAS managed with PTRA Noble Gracious, Safeer, Jose Thomas, Sajeev Kumar, Mohandas, Gomathy, Jacob George, Ramdas Pisharody, AK Gupta Department of Nephrology, Medical College, Thiruvananthapuram, India
Transplant renal artery stenosis (TRAS) is a potentially curable cause of post-transplant arterial hypertension, allograft dysfunction and graft loss. It usually occurs 3 months to 2 years after transplantation. Anastomotic site stenosis, in a recent transplant is conventionally managed with surgery and reanastomosis. Here, we report a case of TRAS very close to anastomotic site. 21-year-old boy who underwent live-related donor transplantation, developed graft dysfunction and accelerated hypertension on the 8th postoperative day. He was managed successfully with percutaneous transluminal renal angioplasty (PTRA) on the 19th postoperative day after which there was excellent improvement in graft function as well as hypertension. We report this case because this could be one of the few cases of early Anastomotic site TRAS managed successfully with PTRA rather than surgery.
09 doi: 10.1016/S2212-0017(11)60013-0 Tacrolimus-induced neurotoxicity Ajay Marwaha, Ravi Angral, SPS Subhramanian, A Khullar, T Kataria, RS Chahal Kidney Hospital and Lifeline, Jalandhar, Punjab, India
Introduction: Tacrolimus (FK506) is an effective immunosuppressive agent for the prevention of organ transplant rejection. Neurological complications of tacrolimus therapy that have been reported are usually mild, i.e., tremors, paraesthesia but occasionally severe, i.e., aphasia, ataxia, confusion, seizures. We observed an unusual case of severe encephalopathy which occurred after 24 hours of renal transplantation in the absence of metabolic abnormalities and neurological diseases. Materials and methods: 42 years male; Basic Disease: CGN/ESRD/ HCV +ve. He underwent renal transplantation on July 2011. The donor was his wife. He was started on Triple Immunosuppressant’s: Tacrolimus, Mycophenolate mofetil and Prednisolone. 1 g solumedrol was given at the time of induction. Tacrolimus was started at the dose of 11 mg/day (2 mg/kg body wt.). Postoperatively, he was having good diuresis and his Sr. Creat came down from 2.5 to 0.9, and Sr. Electrolytes were within normal limits. After 24 hours of surgery, patient started c/o headache, irritability, irrelevant talks. Neurological consult was taken and he was diagnosed as having acute delirium state and he was advised CT Head and CSF study. Thinking of the possibility of steroid-induced psychosis and