- Email: [email protected]
Renal transplantation in infants and children
259
ABSTRACTS The authors report three observations of infantile cystadenoma and discuss its clinical, radiological, and anatomopathological characteristics. It is frequently confused with nephroblastoma, but preoperative radiotherapy will not reduce the size of the tumor. Renal cystadenoma is very rare and there are less than 90 publications in the literature. Renal arteriography shows the following important peculiarities of renal cystadenoma: absence of prompt venous return, lacunar areas and compression en corbeille of the tumor, the hierarchical distribution of the renal arterioles. The macroscopic characteristics of renal cystadenoma are a huge round mass with healthy renal parenchyma. If the diagnosis is in doubt, histological analysis will clarify the position. Renal cystadenoma can coexist with other benign or malignant tumors, e.g., nephroblastoma. Surgery is recommended since this tumor is always monotopic, presents no communication with the urinary tract, and does not disturb the integrity of the adjacent renal parenchyma; moreover, after the removal of the mass, no recurrence or metastasis will occur.-F. Hsu and M. Beffex Complete Renal Fusion (“Cake”/“Lump” Kidney). R. N. Srivastava, M. Singh, 0. P. Ghai, and U. Sethi. Brit. J. Uiol. 43:391394, (August) 1971. Two cases of fused “cake” kidneys are described, with autopsy findings, in children aged 5 yr and 24 days. In each an abdominal mass was palpable clinically. The embryogenesis of the condition is discussed.-7. H. 7ohnston Ectopic Kidney in Children Grunder and J. BrueziBre. 12:113-120,197l.
(25 Cases). M. Ann. Chir. Inf.
The authors report 25 cases of ectopic kidney, divided into two main groups: (I) Simple ectopy, which is generally well tolerated and involves only malposition of the kidney. The position of the ectopic kidney is most frequently pelvic, less frequently lumbar or iliac. The superficially situated simple ectopic kidney, which is exposed to repeated trauma and hematuria, should be removed. (2) Ectopy associated with other multiple malformations; this
type of ectopy includes renal agenesis on the opposite side or horseshoe kidnev. In ._ this group, the other malformative elements should be considered when surgery is indicated. In general, this diagnosis can be made by intravenous urography, although arteriography and scintigraphy allow a more precise location and study.-F. Hsu nnd M. Bettex Renal Transplantation in Infants and Children. J. S. Najarian, R. L. Simmons, M. B. Tallent, C. M. Kjellstrand, R. L. Vernier, and A. F. Michael. Ann. Surg. 174:583600, (October), 1971. The results of 58 infants and children aged 16 and younger who have had renal transplants at the University of Minnesota Hospital since 1963 are reviewed. Included are two infants aged 2-4 mo, six children aged 1-6, 18 aged 7-10, 16 aged 11-13, and 16 aged 14-16. Donors included 33 parents, two siblings, three aunts, and 20 cadavers. Standard techniques of renal transplantation were utilized in children weighing more than 20 kg. In children weighing less than 20 kg the renal vein is anastomosed to the side of vena cava or common iliac vein and the arterial anastomosis performed to the side of the aorta or common iliac artery. The 24 patients transplanted between 1963 and 1967 are we11 with their first transplant and 15% are well with second transplants. Of the recipients of cadaver kidneys, 16% are well with first kidneys and 16% are well with second kidneys. Of 24 children aged 1-16 transplanted with kidneys from related donors since 1968, one has died and one has lost his kidney. Six children aged 1-16 transplanted with cadaver donors since 1968 all are alive and five have good renal function. The authors stress that patients with obstructive uropathy do as well as patients with nephritis if refluxing ureters are removed and bladder function restored. Diverting ileal loops were constructed for four pediatric transplants. Growth after transplantation parallels normal growth patterns, but posttransplant “catch-up growth” is rare. Growth appears to stop several years earlier than normal in both boys and girls. There was no correlation of growth with source of kidney, histocompatibility, typing, maintenance dose
ABSTRACTS
260 of steroids, or renal function. Patients with steroid-resistant nephrotic syndrome have poor prognosis and the disease may recur in the transplants. Prolonged dialysis may reduce this tendency. Hypertension has been a problem during the postransplant period and requires vigorous antihypertensive measures to avoid central nervous system changes. Transplants performed in infants aged 2-4 mo were technically successful but one infant rejected the transplant 3 mo later and the other died suddenly on the second postransplant day. --Frank G. DeLuca
Cadaveric Renal Transplantation in Children. R. N. Fine, H. H. Edelbrock, L. B. Brennan, C. M. Grushkin, B. M. Korsch, H. Riddell, Q. Stiles, and E. Lieberman. Lancet 1:1087-1091 (May), 1971.
Although cadaveric renal transplantation is an accepted method of treatment for endstage renal disease in adults, its use in the treatment of uremic children is still controversial. In a study of 29 children aged 18 mo to 18 yr., 32 cadaveric renal transplants were made between February 1968 and August 1970. Twenty-five children (86%) and 22 allograFts are surviving 6-32 mo after transplantation. Ten kidneys were lost. Six were removed for irreversible rejection: one for hyperacute rejection, three for acute rejection within 2 mo of transplantation, and two for chronic rejection 17 mo after transplantation. Three kidneys were lost because the recipients died from causes unrelated to rejection: two allografts were functioning and one patient was recovering from acute tubular necrosis at the time of death. The tenth allograft was removed 1 hr after transulantation because of functional venous obstruction. Six children received second allografts from a cadaver donor. Three had previously rejected a parental donor transplant and one had a previous cadaver al!ograft removed for technical reasons. Four of the six second allografts are surviving 6-21 mo after transplantation with excellent function. Two second transplants were removed for rejection. Details of transplantation, histocompatibility, and growth of recipients are given.W. M. Dennison
Experimental
Bridging
of Ureteral
Defects
by Free Ureteral Grafts: A Study in Dogs. R. S. Sethi, Amarjit Singh, and Waryam Singh. Ind. J. Surg. 32:358-364 (July), 1970. Twenty-four mongrel dogs were nephrectomized on one side, and free autogenous ureteral grafts 3.5 cm in length were used to bridge the ureteral defect of the same length on the other side. They were divided into three groups. In one no attempt was made to improve the blood. supply of the graft; in the second group the graft was wrapped in omentum; and in the third group it was tunneled subserously through the wall of the sigmoid colon. Results were best in the last group.-R. K. Gandhi Closed Traumatic Rupture of the Upper Ureter in Children. M. Lacheretz, M. Lejeune, D. Barberis, and J. De/hay, Ann. Chir. Inf. 12:125-132, 1971. The authors report a case of traumatic rupture of the upper ureter following a traffic accident in a child aged 7 yr. Ureteral rupture following abdominal contusion is rare. Only 23 cases have been reported in the past 20 yr, of which nine were younger than 10 yr of age. The ureteral rupture is always accompanied by polytraumatism. The diagnosis is very difficult, as the symptoms are latent. The diagnosis can be made by the finding of urine in the lumbar fossa by the IVU or the formation of a pseudocyst. In most cases, there is an absence of hematuria. Before 1950, nephrectomy was usually done but more recently pyeloureteral anastomosis has been successfully performed. The prognosis is more favorable if the pyelo-ureteral anastomosis is done during the first month after accident.F. Hsu and M. Bettex Longitudinal Ureteroplasty (Hendren’s Operation). G. Monfort, J. P. Giraud, 13. Unal, and M. Carcassonne. Ann. Chir. Inf. 12: 221-224,1971. The authors report 22 cases of longitudinal ureteroplasty: five aged over 2, II aged between 3 mo and 2 yr, and six under the age of 3 mo. The authors list the merits of Hendren’s operation, mentioning especially the possibility of using this method on infants. Of the first group of five children
ABSTRACTS The authors report three observations of infantile cystadenoma and discuss its clinical, radiological, and anatomopathological characteristics. It is frequently confused with nephroblastoma, but preoperative radiotherapy will not reduce the size of the tumor. Renal cystadenoma is very rare and there are less than 90 publications in the literature. Renal arteriography shows the following important peculiarities of renal cystadenoma: absence of prompt venous return, lacunar areas and compression en corbeille of the tumor, the hierarchical distribution of the renal arterioles. The macroscopic characteristics of renal cystadenoma are a huge round mass with healthy renal parenchyma. If the diagnosis is in doubt, histological analysis will clarify the position. Renal cystadenoma can coexist with other benign or malignant tumors, e.g., nephroblastoma. Surgery is recommended since this tumor is always monotopic, presents no communication with the urinary tract, and does not disturb the integrity of the adjacent renal parenchyma; moreover, after the removal of the mass, no recurrence or metastasis will occur.-F. Hsu and M. Beffex Complete Renal Fusion (“Cake”/“Lump” Kidney). R. N. Srivastava, M. Singh, 0. P. Ghai, and U. Sethi. Brit. J. Uiol. 43:391394, (August) 1971. Two cases of fused “cake” kidneys are described, with autopsy findings, in children aged 5 yr and 24 days. In each an abdominal mass was palpable clinically. The embryogenesis of the condition is discussed.-7. H. 7ohnston Ectopic Kidney in Children Grunder and J. BrueziBre. 12:113-120,197l.
(25 Cases). M. Ann. Chir. Inf.
The authors report 25 cases of ectopic kidney, divided into two main groups: (I) Simple ectopy, which is generally well tolerated and involves only malposition of the kidney. The position of the ectopic kidney is most frequently pelvic, less frequently lumbar or iliac. The superficially situated simple ectopic kidney, which is exposed to repeated trauma and hematuria, should be removed. (2) Ectopy associated with other multiple malformations; this
type of ectopy includes renal agenesis on the opposite side or horseshoe kidnev. In ._ this group, the other malformative elements should be considered when surgery is indicated. In general, this diagnosis can be made by intravenous urography, although arteriography and scintigraphy allow a more precise location and study.-F. Hsu nnd M. Bettex Renal Transplantation in Infants and Children. J. S. Najarian, R. L. Simmons, M. B. Tallent, C. M. Kjellstrand, R. L. Vernier, and A. F. Michael. Ann. Surg. 174:583600, (October), 1971. The results of 58 infants and children aged 16 and younger who have had renal transplants at the University of Minnesota Hospital since 1963 are reviewed. Included are two infants aged 2-4 mo, six children aged 1-6, 18 aged 7-10, 16 aged 11-13, and 16 aged 14-16. Donors included 33 parents, two siblings, three aunts, and 20 cadavers. Standard techniques of renal transplantation were utilized in children weighing more than 20 kg. In children weighing less than 20 kg the renal vein is anastomosed to the side of vena cava or common iliac vein and the arterial anastomosis performed to the side of the aorta or common iliac artery. The 24 patients transplanted between 1963 and 1967 are we11 with their first transplant and 15% are well with second transplants. Of the recipients of cadaver kidneys, 16% are well with first kidneys and 16% are well with second kidneys. Of 24 children aged 1-16 transplanted with kidneys from related donors since 1968, one has died and one has lost his kidney. Six children aged 1-16 transplanted with cadaver donors since 1968 all are alive and five have good renal function. The authors stress that patients with obstructive uropathy do as well as patients with nephritis if refluxing ureters are removed and bladder function restored. Diverting ileal loops were constructed for four pediatric transplants. Growth after transplantation parallels normal growth patterns, but posttransplant “catch-up growth” is rare. Growth appears to stop several years earlier than normal in both boys and girls. There was no correlation of growth with source of kidney, histocompatibility, typing, maintenance dose
ABSTRACTS
260 of steroids, or renal function. Patients with steroid-resistant nephrotic syndrome have poor prognosis and the disease may recur in the transplants. Prolonged dialysis may reduce this tendency. Hypertension has been a problem during the postransplant period and requires vigorous antihypertensive measures to avoid central nervous system changes. Transplants performed in infants aged 2-4 mo were technically successful but one infant rejected the transplant 3 mo later and the other died suddenly on the second postransplant day. --Frank G. DeLuca
Cadaveric Renal Transplantation in Children. R. N. Fine, H. H. Edelbrock, L. B. Brennan, C. M. Grushkin, B. M. Korsch, H. Riddell, Q. Stiles, and E. Lieberman. Lancet 1:1087-1091 (May), 1971.
Although cadaveric renal transplantation is an accepted method of treatment for endstage renal disease in adults, its use in the treatment of uremic children is still controversial. In a study of 29 children aged 18 mo to 18 yr., 32 cadaveric renal transplants were made between February 1968 and August 1970. Twenty-five children (86%) and 22 allograFts are surviving 6-32 mo after transplantation. Ten kidneys were lost. Six were removed for irreversible rejection: one for hyperacute rejection, three for acute rejection within 2 mo of transplantation, and two for chronic rejection 17 mo after transplantation. Three kidneys were lost because the recipients died from causes unrelated to rejection: two allografts were functioning and one patient was recovering from acute tubular necrosis at the time of death. The tenth allograft was removed 1 hr after transulantation because of functional venous obstruction. Six children received second allografts from a cadaver donor. Three had previously rejected a parental donor transplant and one had a previous cadaver al!ograft removed for technical reasons. Four of the six second allografts are surviving 6-21 mo after transplantation with excellent function. Two second transplants were removed for rejection. Details of transplantation, histocompatibility, and growth of recipients are given.W. M. Dennison
Experimental
Bridging
of Ureteral
Defects
by Free Ureteral Grafts: A Study in Dogs. R. S. Sethi, Amarjit Singh, and Waryam Singh. Ind. J. Surg. 32:358-364 (July), 1970. Twenty-four mongrel dogs were nephrectomized on one side, and free autogenous ureteral grafts 3.5 cm in length were used to bridge the ureteral defect of the same length on the other side. They were divided into three groups. In one no attempt was made to improve the blood. supply of the graft; in the second group the graft was wrapped in omentum; and in the third group it was tunneled subserously through the wall of the sigmoid colon. Results were best in the last group.-R. K. Gandhi Closed Traumatic Rupture of the Upper Ureter in Children. M. Lacheretz, M. Lejeune, D. Barberis, and J. De/hay, Ann. Chir. Inf. 12:125-132, 1971. The authors report a case of traumatic rupture of the upper ureter following a traffic accident in a child aged 7 yr. Ureteral rupture following abdominal contusion is rare. Only 23 cases have been reported in the past 20 yr, of which nine were younger than 10 yr of age. The ureteral rupture is always accompanied by polytraumatism. The diagnosis is very difficult, as the symptoms are latent. The diagnosis can be made by the finding of urine in the lumbar fossa by the IVU or the formation of a pseudocyst. In most cases, there is an absence of hematuria. Before 1950, nephrectomy was usually done but more recently pyeloureteral anastomosis has been successfully performed. The prognosis is more favorable if the pyelo-ureteral anastomosis is done during the first month after accident.F. Hsu and M. Bettex Longitudinal Ureteroplasty (Hendren’s Operation). G. Monfort, J. P. Giraud, 13. Unal, and M. Carcassonne. Ann. Chir. Inf. 12: 221-224,1971. The authors report 22 cases of longitudinal ureteroplasty: five aged over 2, II aged between 3 mo and 2 yr, and six under the age of 3 mo. The authors list the merits of Hendren’s operation, mentioning especially the possibility of using this method on infants. Of the first group of five children