- Email: [email protected]
REPERFUSION INJURY
Vol. 179, No. 4, Supplement, Wednesday, May 21, 2008
Groups 1 and 2 were 38 years (range 13 - 52) and 35 years (range 15 48) respectively and male female ratio was similar in both groups. The PHDQVL]HRIWKHNLGQH\VUHPRYHGZHUHFPDQGFPUHVSHFWLYHO\LQ Groups 1 and 2 respectively. Operative time was longer in Group 2(178 min, range 118 - 212 min) compared to Group 1(100 min, range 82 - 154 min) (p<0.05). The postoperative pain scroes, analgesic requirement, blood transfusion rate, surgical complications, hospital stay and time for convalescence were similar between two groups. The total cost for the nephrectomy by laparoscopy was 3.5 times that of dorsal lumbotomy. The mean time interval between nephrectomy and transplant was 28 days (21 to 42 days) which was similar in both groups. CONCLUSIONS: Bilateral dorsal lumbotomy appears to score over laparoscopic approach in pretransplant nephrectomy for small kidneys because of comparable morbidity, post operative outcomes, VLJQL¿FDQWO\VKRUWHURSHUDWLYHWLPHDQGOHVVHUFRVW Source of Funding: None
2020 LOWER URINARY TRACT RECONSTRUCTION AND RENAL TRANSPLANTATION: 19-YEAR EXPERIENCE William C Nahas*, Marcos Lucon, Hideki Kanashiro, Ioannis M Antonopoulos, Affonso C Piovesan, Renato Falci, Fernando Saito, Elias David-Neto, Luiz E Ianhez, Miguel Srougi. Sao Paulo, Brazil. INTRODUCTION AND OBJECTIVE: For a successful renal transplant, the inferior urinary tract has to provide a reservoir capable of FDUU\LQJDQDGHTXDWHYROXPHDWORZSUHVVXUHVDQGWRDOORZDQHI¿FLHQW method of drainage. The experience with kidney transplant in patients with severe lower tract dysfunction is presented. METHODS: Between 1988 and 2007, 1903 kidney transplants were performed at our service. 46 patients with severe lower urinary tract abnormalities underwent 52 Kd Tx and urinary tract reconstruction. 22 were female and 24 male. Mean age at transplantation was 23.9 (4-53) years. The etiology of bladder dysfunction was neurogenic bladder (21pts.), tuberculosis (7pts), posterior urethral valve (6pts), YHVLFRXUHWHUDOUHÀX[ SWV DQGRWKHUV SWV %ODGGHUDXJPHQWDWLRQ was performed in 39 patients (44 Kd Tx) and seven patients received a kidney into a urinary diversion (8 Kd Tx). Bladder enlargement was done with a bowel segment in 31 and with the ureter in 8 patients. Bladder capacity and compliance were markedly improved, except in 2 patients initially submitted to ureterocystoplasty who needed a second enlargement with an intestinal segment. The transplant was performed by an extraperitoneal access in a classic way. Whenever possible the XUHWHUZDVLPSODQWHGLQWRWKHEODGGHU LWZDVLPSODQWHGLQWRWKHERZHO segment in 18 patients (10 augmented, 8 urinary diversions), in two cases an ureterouretero anastomosis was done. A double “J” catheter was left in 9 patients. RESULTS: The mean follow up and serum creatinine at the last follow up was 45.8 (0-196) months and 1.89 (0.5-6.1) mg/dl, respectively. 7KH XURORJLFDO FRPSOLFDWLRQV LQFOXGHG RQH SDWLHQW ZLWK XULQDU\ ¿VWXOD and two ureteric stenosis, all treated with success. One patient with arterial thrombosis lost his graft. 24 patients empty their bladder by CIC. Urinary tract infection was the most frequent complication. Thirteen grafts were lost, just one related with the urinary reconstruction. Five patients received a second transplant during the follow up. Ten patients died, one related to the urinary reconstruction. The actuarial graft survival was 98.1%, 93.7% e 83.2% at 12, 36 and 60 months. CONCLUSIONS: Kidney transplantation is safe and effective even in patients with severe lower urinary tract disorders. Corrections of VWUXFWXUDODQRPDOLHVDQGRSWLPL]DWLRQRIVWRUDJHDQGHPSW\LQJIXQFWLRQ should be done before transplantation. When dilated the ureter is our ¿UVWFKRLFHIRUEODGGHUDXJPHQWDWLRQLIQRWDERZHOVHJPHQWLVWKHVROH solution. Urinary diversion is rarely required today. Source of Funding: None
THE JOURNAL OF UROLOGY®
695
2021 MACROPHAGE RECRUITMENT AND IL-10 INDUCTION CORRELATE WITH PROTECTION PROVIDED BY RENAL ISCHEMIC PRECONDITIONING ATTENUATES RENAL ISCHEMIA/ REPERFUSION INJURY Nobuyuki Fukuzawa*, Austin D Schenk, Katsuya Nonomura, Robert L Fairchild. Cleveland, OH, and Sapporo, Japan. INTRODUCTION AND OBJECTIVE: Ischemic preconditioning (IP) attenuates renal injury to a second more intense ischemic insult but mechanisms underlying this protection are unclear. This study investigated mechanisms contributing to the protective effects of IP. METHODS: Groups of C57BL/6 mice were subjected to bilateral renal occlusion for 45 minutes to induce renal ischemia/ reperfusion injury (IRI) or sham laparotomy without occlusion with body temperatures maintained at 32 °C. Five days before IRI, some groups were subjected to kidney IP by bilateral renal occlusion for 30 minutes (IP group) or sham laparotomy. Serum creatinine (sCr) and blood urea nitrogen (BUN) were measured at 24-hour intervals following reperfusion of IRI. Flow cytometry and immunohistochemistry (IHC) were used to TXDQWLI\ QHXWURSKLO DQG PDFURSKDJH UHQDO LQ¿OWUDWLRQ DQG KRXUV after IRI. Real-time PCR and ELISA were used to measure CXCL1, CXCL2, CCL2 and IL-10 mRNA transcripts and proteins. To test the role of IL-10 in IP anti-IL10 receptor antibody was injected 30 minutes after reperfusion of IRI. RESULTS: IP decreased sCr levels 3-fold vs the control IRI JURXS FRQWURO,5, PJGO,3 PJGO DWKRXUV after reperfusion. All animals in the control group died within 4 days after IRI whereas IP resulted in complete survival. IRI was associated ZLWKKLJKH[SUHVVLRQRI&;&/DQG&;&/DQGQHXWURSKLOLQ¿OWUDWLRQ FRQWURO,5, [A FHOOVJRIWLVVXH ,3 [A cells/g of tissue) into ischemic kidneys that was reduced 2-fold with IP. In contrast, levels of the macrophage chemoattractant CCL2 (control IRI: 86.6 ± 18.4 pg/mg total protein vs. IP: 522 ± 189 pg/mg total SURWHLQ DQGPDFURSKDJHLQ¿OWUDWLRQLQWRWKHNLGQH\SDUHQFK\PDZHUH VLJQL¿FDQWO\HOHYDWHGLQWKH,3JURXSIROORZLQJWKHVHFRQGLQMXU\ EXW not before). Marked increases of IL-10 mRNA and protein levels were also observed in the IP group. Treatment of the IP group with anti-IL-10 receptor antibody immediately after IRI increased sCr and BUN levels DQGQHXWURSKLOLQ¿OWUDWLRQLQWRLVFKHPLFNLGQH\V CONCLUSIONS: Increased macrophage recruitment and increased production of IL-10 during IRI are associated with the survival advantage conferred by ischemic preconditioning. Source of Funding: ischemic preconditioning, ischemia preconditioning, kidney, macrohage, IL-10, chemokine, cytokine, IRI, ischemia reperfusion.
2022 KIDNEY OUTCOME IN THE CONTEXT OF COMBINED LIVERKIDNEY TRANSPLANTATION Eduard Garcia*, Vicenc Torregrosa, Rafael Gutierrez, Federico Oppenheimer, Antonio Alcaraz. Barcelona, Spain. INTRODUCTION AND OBJECTIVE: To report our experience with combined liver-kidney transplantation (CLKT). METHODS: Retrospective review of our CLKT excel database. Receptors were 24 males and 14 females. Mean age 51 years (range 19-65 years). Main entitities producing end-stage liver disease were HCV in 17 patients (48,5%), alcoholism in 10 patients (28,5%) and Hyperoxaluria in 3 patients (8,5%). Regarding end-stage renal disease, IgA nephropathy in 6 patients (17,1%), Polycystosis in 6 patients (17,1%), Nephroangiosclerosis in 4 patients (11,4%) and Hyperoxaluria in 3 patients (8,5%) were most commonly implicated. 29 patients had no previous renal transplantation. RESULTS: Between May 1993 and July 2007, 38 combined liver-kidney transplantations (CLKT) were performed in Hospital Clinic i Provincial de Barcelona. Reintervention rate was 38, 9%. Renal primary graft non function was 2,7%. Delayed graft function was 13,1%. Renal graft loss at 1,5 and 12 years was 100%, 93% and 75%. Liver graft loss at 1,5 and 12 years was 97%, 94% and 94%. Mean follow-up was 4,75 years. Raw mortality rate was 16%. Patients without previous renal transplantation had better life expectancy (p=0,0009), when compared with those patients who had previous renal transplantation.
Groups 1 and 2 were 38 years (range 13 - 52) and 35 years (range 15 48) respectively and male female ratio was similar in both groups. The PHDQVL]HRIWKHNLGQH\VUHPRYHGZHUHFPDQGFPUHVSHFWLYHO\LQ Groups 1 and 2 respectively. Operative time was longer in Group 2(178 min, range 118 - 212 min) compared to Group 1(100 min, range 82 - 154 min) (p<0.05). The postoperative pain scroes, analgesic requirement, blood transfusion rate, surgical complications, hospital stay and time for convalescence were similar between two groups. The total cost for the nephrectomy by laparoscopy was 3.5 times that of dorsal lumbotomy. The mean time interval between nephrectomy and transplant was 28 days (21 to 42 days) which was similar in both groups. CONCLUSIONS: Bilateral dorsal lumbotomy appears to score over laparoscopic approach in pretransplant nephrectomy for small kidneys because of comparable morbidity, post operative outcomes, VLJQL¿FDQWO\VKRUWHURSHUDWLYHWLPHDQGOHVVHUFRVW Source of Funding: None
2020 LOWER URINARY TRACT RECONSTRUCTION AND RENAL TRANSPLANTATION: 19-YEAR EXPERIENCE William C Nahas*, Marcos Lucon, Hideki Kanashiro, Ioannis M Antonopoulos, Affonso C Piovesan, Renato Falci, Fernando Saito, Elias David-Neto, Luiz E Ianhez, Miguel Srougi. Sao Paulo, Brazil. INTRODUCTION AND OBJECTIVE: For a successful renal transplant, the inferior urinary tract has to provide a reservoir capable of FDUU\LQJDQDGHTXDWHYROXPHDWORZSUHVVXUHVDQGWRDOORZDQHI¿FLHQW method of drainage. The experience with kidney transplant in patients with severe lower tract dysfunction is presented. METHODS: Between 1988 and 2007, 1903 kidney transplants were performed at our service. 46 patients with severe lower urinary tract abnormalities underwent 52 Kd Tx and urinary tract reconstruction. 22 were female and 24 male. Mean age at transplantation was 23.9 (4-53) years. The etiology of bladder dysfunction was neurogenic bladder (21pts.), tuberculosis (7pts), posterior urethral valve (6pts), YHVLFRXUHWHUDOUHÀX[ SWV DQGRWKHUV SWV %ODGGHUDXJPHQWDWLRQ was performed in 39 patients (44 Kd Tx) and seven patients received a kidney into a urinary diversion (8 Kd Tx). Bladder enlargement was done with a bowel segment in 31 and with the ureter in 8 patients. Bladder capacity and compliance were markedly improved, except in 2 patients initially submitted to ureterocystoplasty who needed a second enlargement with an intestinal segment. The transplant was performed by an extraperitoneal access in a classic way. Whenever possible the XUHWHUZDVLPSODQWHGLQWRWKHEODGGHU LWZDVLPSODQWHGLQWRWKHERZHO segment in 18 patients (10 augmented, 8 urinary diversions), in two cases an ureterouretero anastomosis was done. A double “J” catheter was left in 9 patients. RESULTS: The mean follow up and serum creatinine at the last follow up was 45.8 (0-196) months and 1.89 (0.5-6.1) mg/dl, respectively. 7KH XURORJLFDO FRPSOLFDWLRQV LQFOXGHG RQH SDWLHQW ZLWK XULQDU\ ¿VWXOD and two ureteric stenosis, all treated with success. One patient with arterial thrombosis lost his graft. 24 patients empty their bladder by CIC. Urinary tract infection was the most frequent complication. Thirteen grafts were lost, just one related with the urinary reconstruction. Five patients received a second transplant during the follow up. Ten patients died, one related to the urinary reconstruction. The actuarial graft survival was 98.1%, 93.7% e 83.2% at 12, 36 and 60 months. CONCLUSIONS: Kidney transplantation is safe and effective even in patients with severe lower urinary tract disorders. Corrections of VWUXFWXUDODQRPDOLHVDQGRSWLPL]DWLRQRIVWRUDJHDQGHPSW\LQJIXQFWLRQ should be done before transplantation. When dilated the ureter is our ¿UVWFKRLFHIRUEODGGHUDXJPHQWDWLRQLIQRWDERZHOVHJPHQWLVWKHVROH solution. Urinary diversion is rarely required today. Source of Funding: None
THE JOURNAL OF UROLOGY®
695
2021 MACROPHAGE RECRUITMENT AND IL-10 INDUCTION CORRELATE WITH PROTECTION PROVIDED BY RENAL ISCHEMIC PRECONDITIONING ATTENUATES RENAL ISCHEMIA/ REPERFUSION INJURY Nobuyuki Fukuzawa*, Austin D Schenk, Katsuya Nonomura, Robert L Fairchild. Cleveland, OH, and Sapporo, Japan. INTRODUCTION AND OBJECTIVE: Ischemic preconditioning (IP) attenuates renal injury to a second more intense ischemic insult but mechanisms underlying this protection are unclear. This study investigated mechanisms contributing to the protective effects of IP. METHODS: Groups of C57BL/6 mice were subjected to bilateral renal occlusion for 45 minutes to induce renal ischemia/ reperfusion injury (IRI) or sham laparotomy without occlusion with body temperatures maintained at 32 °C. Five days before IRI, some groups were subjected to kidney IP by bilateral renal occlusion for 30 minutes (IP group) or sham laparotomy. Serum creatinine (sCr) and blood urea nitrogen (BUN) were measured at 24-hour intervals following reperfusion of IRI. Flow cytometry and immunohistochemistry (IHC) were used to TXDQWLI\ QHXWURSKLO DQG PDFURSKDJH UHQDO LQ¿OWUDWLRQ DQG KRXUV after IRI. Real-time PCR and ELISA were used to measure CXCL1, CXCL2, CCL2 and IL-10 mRNA transcripts and proteins. To test the role of IL-10 in IP anti-IL10 receptor antibody was injected 30 minutes after reperfusion of IRI. RESULTS: IP decreased sCr levels 3-fold vs the control IRI JURXS FRQWURO,5, PJGO,3 PJGO DWKRXUV after reperfusion. All animals in the control group died within 4 days after IRI whereas IP resulted in complete survival. IRI was associated ZLWKKLJKH[SUHVVLRQRI&;&/DQG&;&/DQGQHXWURSKLOLQ¿OWUDWLRQ FRQWURO,5, [A FHOOVJRIWLVVXH ,3 [A cells/g of tissue) into ischemic kidneys that was reduced 2-fold with IP. In contrast, levels of the macrophage chemoattractant CCL2 (control IRI: 86.6 ± 18.4 pg/mg total protein vs. IP: 522 ± 189 pg/mg total SURWHLQ DQGPDFURSKDJHLQ¿OWUDWLRQLQWRWKHNLGQH\SDUHQFK\PDZHUH VLJQL¿FDQWO\HOHYDWHGLQWKH,3JURXSIROORZLQJWKHVHFRQGLQMXU\ EXW not before). Marked increases of IL-10 mRNA and protein levels were also observed in the IP group. Treatment of the IP group with anti-IL-10 receptor antibody immediately after IRI increased sCr and BUN levels DQGQHXWURSKLOLQ¿OWUDWLRQLQWRLVFKHPLFNLGQH\V CONCLUSIONS: Increased macrophage recruitment and increased production of IL-10 during IRI are associated with the survival advantage conferred by ischemic preconditioning. Source of Funding: ischemic preconditioning, ischemia preconditioning, kidney, macrohage, IL-10, chemokine, cytokine, IRI, ischemia reperfusion.
2022 KIDNEY OUTCOME IN THE CONTEXT OF COMBINED LIVERKIDNEY TRANSPLANTATION Eduard Garcia*, Vicenc Torregrosa, Rafael Gutierrez, Federico Oppenheimer, Antonio Alcaraz. Barcelona, Spain. INTRODUCTION AND OBJECTIVE: To report our experience with combined liver-kidney transplantation (CLKT). METHODS: Retrospective review of our CLKT excel database. Receptors were 24 males and 14 females. Mean age 51 years (range 19-65 years). Main entitities producing end-stage liver disease were HCV in 17 patients (48,5%), alcoholism in 10 patients (28,5%) and Hyperoxaluria in 3 patients (8,5%). Regarding end-stage renal disease, IgA nephropathy in 6 patients (17,1%), Polycystosis in 6 patients (17,1%), Nephroangiosclerosis in 4 patients (11,4%) and Hyperoxaluria in 3 patients (8,5%) were most commonly implicated. 29 patients had no previous renal transplantation. RESULTS: Between May 1993 and July 2007, 38 combined liver-kidney transplantations (CLKT) were performed in Hospital Clinic i Provincial de Barcelona. Reintervention rate was 38, 9%. Renal primary graft non function was 2,7%. Delayed graft function was 13,1%. Renal graft loss at 1,5 and 12 years was 100%, 93% and 75%. Liver graft loss at 1,5 and 12 years was 97%, 94% and 94%. Mean follow-up was 4,75 years. Raw mortality rate was 16%. Patients without previous renal transplantation had better life expectancy (p=0,0009), when compared with those patients who had previous renal transplantation.