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665Urological way in double kidney transplantation (DKT): Our experience
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666
U R O L O G I C A L WAY IN DOUBLE KIDNEY TRANSPLANTATION (DKT): O U R EXPERIENCE
COMPARATIVE STUDY OF LIDOCAINE AND LASIX EFFECTS IN DIURESIS AND F U N C T I O N G R A F T A F T E R R E N A L TRANSPLANTATION
Lasaponara E, Paradiso M., Morabito F., Cucchiarale G., Graziano M.E., LiberaIe F., Torta E., Segoloni G., Ferrando U. Ospedale San Giovamai Battista Tofino Italia, Kidney Transplantation Department, Torino, Italy INTRODUCTION & OBJECTIVES: Because of graft shortage waiting list for kidney transplant increased. Patients with chronic renal failure are allowed by dialysis to survive until an older age than in the past; besides age itself does not brake now the waiting list admittance. Real possibility for aged people to obtain a graft is very small: this induced us looking for a new chance of kidney transplant also for aged patients lying in waiting list. For this therapeutic option organs judged not guarantying "in single" to have a sufficient number of nephrons to maintain a good renal function are used for aged patients with low life expectancy. MATERIAL & METHODS: Grafts from >50 aged donors are accepted, with low bioptic score and clearance < 60 ml/min. Using kidney from aged donors frequently is necessary to adjust pathological findings (cysts, stones), fur this reason, during grafts inspections, great attention is due to morphological and instrumental survey, especially to exclude any neoplasm. Often receivers themselves (aged <55) complain pluripathology, particularly anatomo-functional diseases of the urinary tract (BPH, urethral stricture) and higher incidence of genito-urinary tract neoplasm. Prostate, kidneys, urothelium must be accurately looked for during preoperative urological control. Surgical time is extended by double uretero-vesical anastomosis, often more difficult because of tissue quality. Others authors reported increased (30%) urological complications performing DKT. Vasctilarization is low in aged people and this can be the reason of early anastomotic failure and late ureteral necrosis or stricture. RESULTS: During last 5 years we performed 69 DKT in patients aged 55-74 (range 61), using grafts from donors aged 50-84 (range 70). Renal function 10 days after double grafting is very satisfying crea range 5.8mg/ml; 1 month later crea range 1.9. We complained 3 urine leakages out of 138 reno-ureteral units: 1 uretero-vesical neoanastomosis, 1 pyelopyeloanastomosis because of a complete ureteral necrosis, 1 uretero-m'eteroanastomosis were performed, last two cases using native urinary tract. Ureteral stricture in 2 cases was resolved by transcutaneous procedure with balloon. 2 patients underwent to TURP 3 weeks after DKT and 1 to isterectomy and colposacropexy because of pelvic descent and urinary incontinence. 5 patients had a graft nephrectomy: bilateral by neoplasm in one case, by vascular cause in another one; monolateral in 3 cases due to vascular disease. We complain also 3 UTI, i symptomatic bilateral VUR underwent to endoscopic submucosal injection of Coaptite. One case, 3 years after DKT developed a papillary carcinoma of the bladder, treated by TURB. CONCLUSIONS: Our rate of early urological complications appears low; this despite anatomo-functional conditions of the aged grafts and the aged recivers. Highest urological attention in all phases (before, during, and after) transplant is due.
Razaghi M,R., Heidari F., Zadeh Modares S. Shohada Tajrish Hospital, Dep. of Urology, Tehran, Iran I N T R O D U C T I O N & OBJECTIVES: Renal grating is the ideal treatment for patient suffering from chronic renal failure. It is frequently encountered that in spite of using good surgical and anaesthsiologic techniques, some patients do not have adequate urinary output and cortical microvascular spasm be the cause of this problem and whether eliminating spasm by vasodilators increases urinary output and hence better graft function? M A T E R I A L & METHODS: In order to answer this question we designed a randomized clinical trial the candidates for renal transplantation who referred to Tajrish Shohada Hospital from July 2002 to December 2003 were included in the study after gaining patients consent and observing medical ethics the patients were blindly given Lidocaine injection into graft renal artery prior to anastomosis conventionally treated with Lasix them urine volume at different times after surgery and serum creatinin were serially determined and compared between two groups. RESULTS: Urinary output at one, four, and 24 hrs after surgery in Lidocaine group was considerably higher than Lasix group (p<0.001)and serum Cr. levels at 2 and 21 days after surgery were also lower in the intervention group. CONCLUSIONS: According to previous studies, Lidocaine can be used as a suitable antispasmodic agent in vascular surgery procedures and our study showed that its employment in renal transplantation can produce better perfusion and so higher urinary output and more favourable graft function.
667
668
NEW DIAGNOSTIC M A R K E R FOR UPJO
R O L E OF PRE=TRANSPLANTATION S M O K I N G ON A L L O G R A F T SURVIVAL IN KIDNEY RECIPIENTS
Falahatkar S?, Shamsa A. 2
Kheradmand A., Shahbazian H. Jundishpour Medical University, Urology, Ahvaz, Iran
~Razi Hospital Guilan University, Dept. of Urology, Rasht, Iran, 2MUMS, Dept. of Urology, Mashhad, Iran
I N T R O D U C T I O N & OBJECTIVES: The purpose of this study was to
I N T R O D U C T I O N & OBJECTIVES: Cigarette smoking contributes to a number of health-related problems, but its impact on allograft survival in renal transplantation is not clear. This study is performed to evaluate the relationship between smoking and graft survival.
investigate a significant association between antigens of HLA system and congenital UPJO and whether we can use HLA typing as a diagnostic marker in diagnosis of UP J0?
M A T E R I A L & METHODS: The study included 30 patients with congenital UPJO which diagnosed by imaging study. Control subjects were selected from kidney donors. The number of control subjects were two times as many UPJO patients.
RESULTS: According to age the most call on was at the forth period of life. 55% were female and 45% were male. The most common symptom was flank pain. Statistics accounts showed a significant relationship (p value=0.05) between hla-a30-b7-cw4 and congenital UPJO.
CONCLUSIONS: It is necessary to do more study to investigate antigens of HLA system which have a significant association with congenital UPJO and whether HLA typing can be a diagnostic marker in diagnosis of congenital UPJO?
M A T E R I A L & METHODS: 199 adult kidney recipients were evaluated. All operations were done in our centre and all grafts were taken from living donors. All patients were asked about cigarette smoking before transplantation and evaluated for diabetes mellitus, hypertension and hyperlipidemia during pretransplantation evaluation and all of above parameters were re-evaluated during post transplantation follow-up. RESULTS: 199 recipients were evaluated that 142 (71.4%) were male and 57 (28.6%) female. Recipients were 18 to 65 years, old. 41 recipients (20.6%) were smoker before transplantation that 87.7% continued to smoke after that. Mean packet-year smoking was 13.2. Hypertension before and after transplantation were 32.7% and 33.7%, for diabetes mellitus was 19.3% and 23.1% and hyperlipidemia was 46.2% and 42.2% that had not significant differences. Pre-transplantation smoking was significantly associates with reduced overall graft survival (P=0.01). But despite other studies no correlation between cessation smoking after transplantation with increase of survival graft was determined that may be to the small number of patients who discontinued smoking. Reduced graft survival in pre-transplantation smokers could not be accounted for by differences in rejection. CONCLUSIONS: Cigarette smoking before kidney transplantation contributes significantly to allograft loss. The effect of smoking on graft outcome is not explained by increasing of rejection. These effects should be emphasized to patients with end-stage renal disease who are considering renal transplantation.
European Urology Supplements 4 (2005) NO. 3, pp. 169
666
U R O L O G I C A L WAY IN DOUBLE KIDNEY TRANSPLANTATION (DKT): O U R EXPERIENCE
COMPARATIVE STUDY OF LIDOCAINE AND LASIX EFFECTS IN DIURESIS AND F U N C T I O N G R A F T A F T E R R E N A L TRANSPLANTATION
Lasaponara E, Paradiso M., Morabito F., Cucchiarale G., Graziano M.E., LiberaIe F., Torta E., Segoloni G., Ferrando U. Ospedale San Giovamai Battista Tofino Italia, Kidney Transplantation Department, Torino, Italy INTRODUCTION & OBJECTIVES: Because of graft shortage waiting list for kidney transplant increased. Patients with chronic renal failure are allowed by dialysis to survive until an older age than in the past; besides age itself does not brake now the waiting list admittance. Real possibility for aged people to obtain a graft is very small: this induced us looking for a new chance of kidney transplant also for aged patients lying in waiting list. For this therapeutic option organs judged not guarantying "in single" to have a sufficient number of nephrons to maintain a good renal function are used for aged patients with low life expectancy. MATERIAL & METHODS: Grafts from >50 aged donors are accepted, with low bioptic score and clearance < 60 ml/min. Using kidney from aged donors frequently is necessary to adjust pathological findings (cysts, stones), fur this reason, during grafts inspections, great attention is due to morphological and instrumental survey, especially to exclude any neoplasm. Often receivers themselves (aged <55) complain pluripathology, particularly anatomo-functional diseases of the urinary tract (BPH, urethral stricture) and higher incidence of genito-urinary tract neoplasm. Prostate, kidneys, urothelium must be accurately looked for during preoperative urological control. Surgical time is extended by double uretero-vesical anastomosis, often more difficult because of tissue quality. Others authors reported increased (30%) urological complications performing DKT. Vasctilarization is low in aged people and this can be the reason of early anastomotic failure and late ureteral necrosis or stricture. RESULTS: During last 5 years we performed 69 DKT in patients aged 55-74 (range 61), using grafts from donors aged 50-84 (range 70). Renal function 10 days after double grafting is very satisfying crea range 5.8mg/ml; 1 month later crea range 1.9. We complained 3 urine leakages out of 138 reno-ureteral units: 1 uretero-vesical neoanastomosis, 1 pyelopyeloanastomosis because of a complete ureteral necrosis, 1 uretero-m'eteroanastomosis were performed, last two cases using native urinary tract. Ureteral stricture in 2 cases was resolved by transcutaneous procedure with balloon. 2 patients underwent to TURP 3 weeks after DKT and 1 to isterectomy and colposacropexy because of pelvic descent and urinary incontinence. 5 patients had a graft nephrectomy: bilateral by neoplasm in one case, by vascular cause in another one; monolateral in 3 cases due to vascular disease. We complain also 3 UTI, i symptomatic bilateral VUR underwent to endoscopic submucosal injection of Coaptite. One case, 3 years after DKT developed a papillary carcinoma of the bladder, treated by TURB. CONCLUSIONS: Our rate of early urological complications appears low; this despite anatomo-functional conditions of the aged grafts and the aged recivers. Highest urological attention in all phases (before, during, and after) transplant is due.
Razaghi M,R., Heidari F., Zadeh Modares S. Shohada Tajrish Hospital, Dep. of Urology, Tehran, Iran I N T R O D U C T I O N & OBJECTIVES: Renal grating is the ideal treatment for patient suffering from chronic renal failure. It is frequently encountered that in spite of using good surgical and anaesthsiologic techniques, some patients do not have adequate urinary output and cortical microvascular spasm be the cause of this problem and whether eliminating spasm by vasodilators increases urinary output and hence better graft function? M A T E R I A L & METHODS: In order to answer this question we designed a randomized clinical trial the candidates for renal transplantation who referred to Tajrish Shohada Hospital from July 2002 to December 2003 were included in the study after gaining patients consent and observing medical ethics the patients were blindly given Lidocaine injection into graft renal artery prior to anastomosis conventionally treated with Lasix them urine volume at different times after surgery and serum creatinin were serially determined and compared between two groups. RESULTS: Urinary output at one, four, and 24 hrs after surgery in Lidocaine group was considerably higher than Lasix group (p<0.001)and serum Cr. levels at 2 and 21 days after surgery were also lower in the intervention group. CONCLUSIONS: According to previous studies, Lidocaine can be used as a suitable antispasmodic agent in vascular surgery procedures and our study showed that its employment in renal transplantation can produce better perfusion and so higher urinary output and more favourable graft function.
667
668
NEW DIAGNOSTIC M A R K E R FOR UPJO
R O L E OF PRE=TRANSPLANTATION S M O K I N G ON A L L O G R A F T SURVIVAL IN KIDNEY RECIPIENTS
Falahatkar S?, Shamsa A. 2
Kheradmand A., Shahbazian H. Jundishpour Medical University, Urology, Ahvaz, Iran
~Razi Hospital Guilan University, Dept. of Urology, Rasht, Iran, 2MUMS, Dept. of Urology, Mashhad, Iran
I N T R O D U C T I O N & OBJECTIVES: The purpose of this study was to
I N T R O D U C T I O N & OBJECTIVES: Cigarette smoking contributes to a number of health-related problems, but its impact on allograft survival in renal transplantation is not clear. This study is performed to evaluate the relationship between smoking and graft survival.
investigate a significant association between antigens of HLA system and congenital UPJO and whether we can use HLA typing as a diagnostic marker in diagnosis of UP J0?
M A T E R I A L & METHODS: The study included 30 patients with congenital UPJO which diagnosed by imaging study. Control subjects were selected from kidney donors. The number of control subjects were two times as many UPJO patients.
RESULTS: According to age the most call on was at the forth period of life. 55% were female and 45% were male. The most common symptom was flank pain. Statistics accounts showed a significant relationship (p value=0.05) between hla-a30-b7-cw4 and congenital UPJO.
CONCLUSIONS: It is necessary to do more study to investigate antigens of HLA system which have a significant association with congenital UPJO and whether HLA typing can be a diagnostic marker in diagnosis of congenital UPJO?
M A T E R I A L & METHODS: 199 adult kidney recipients were evaluated. All operations were done in our centre and all grafts were taken from living donors. All patients were asked about cigarette smoking before transplantation and evaluated for diabetes mellitus, hypertension and hyperlipidemia during pretransplantation evaluation and all of above parameters were re-evaluated during post transplantation follow-up. RESULTS: 199 recipients were evaluated that 142 (71.4%) were male and 57 (28.6%) female. Recipients were 18 to 65 years, old. 41 recipients (20.6%) were smoker before transplantation that 87.7% continued to smoke after that. Mean packet-year smoking was 13.2. Hypertension before and after transplantation were 32.7% and 33.7%, for diabetes mellitus was 19.3% and 23.1% and hyperlipidemia was 46.2% and 42.2% that had not significant differences. Pre-transplantation smoking was significantly associates with reduced overall graft survival (P=0.01). But despite other studies no correlation between cessation smoking after transplantation with increase of survival graft was determined that may be to the small number of patients who discontinued smoking. Reduced graft survival in pre-transplantation smokers could not be accounted for by differences in rejection. CONCLUSIONS: Cigarette smoking before kidney transplantation contributes significantly to allograft loss. The effect of smoking on graft outcome is not explained by increasing of rejection. These effects should be emphasized to patients with end-stage renal disease who are considering renal transplantation.
European Urology Supplements 4 (2005) NO. 3, pp. 169