Search

Abstract: Kidney transplant recipients (KTRs) have greater morbidity and length of stay (LOS) following certain surgical procedures than non‐KTR. Given that appendectomy is one of the most common surgical procedures, we investigated differences in outcomes between 1336 KTR and 2 640 247 non‐KTR postappendectomy at transplant and nontransplant centers in the United States from 2000 to 2011, using NIS data and adjusting for patient‐level and hospital‐level factors. Postoperative complications were identified using ICD‐9 codes. Among KTR, there were no post‐appendectomy in‐hospital deaths, compared to a 0.2% in non‐KTR (P = .5). Overall complications were similar among KTR and non‐KTR (17.0% vs 11.6%; aOR:0.77 1.121.61). LOS and costs were greater for KTR compared to non‐KTR (LOS ratio 1.191.311.45; cost ratio 1.111.171.26). Only 44.8% of KTR had laparoscopic approach compared to 54.5% of non‐KTR, but had similar complication rates (10.6 vs 8.7%, P = .5). When treated at transplant centers, KTR had similar complications (aOR 0.440.791.43), but longer LOS (ratio 1.211.371.55) and greater hospital‐associated costs (ratio 1.191.291.41) than non‐KTR. Conversely, at nontransplant centers, KTR and non‐KTR had similar complications (aOR 0.751.232.0), LOS (ratio 0.840.961.09), and cost (ratio 0.931.011.10). Contrary to other procedures, KTR did not constitute a high‐risk group for patients undergoing appendectomy. [ABSTRACT FROM AUTHOR]

Successful renal transplantation requires low-pressure venous drainage to permit adequate outflow from the allograft. We report here a series of three patients in whom the inferior vena cava as well as bilateral iliac veins were thrombosed, making it necessary to explore less traditional vessels for venous drainage of the renal allograft. We utilized the splanchnic vasculature in two cases and the native left renal vein in another. The resulting atypical intra-abdominal locations of these allografts also presented difficulties for arterial anastomoses and for urinary drainage. Arterial conduits were utilized in two cases to facilitate anastomosis to the common iliac artery or the aorta, and in the third case, the splenic artery was used for arterial inflow. A traditional ureterocystostomy was technically feasible for only one patient. In another, ureteroureterostomy to the native ureter was performed, and in the third case, the creation of an ileal conduit was necessary. All three patients had antibodies to human leukocyte antigens and two required desensitization. All three kidneys had immediate graft function and continued to function at 1 year post-transplant. With a combination of planning, creativity, and persistence, patients with IVC thrombosis can enjoy the benefits of renal transplantation. [ABSTRACT FROM AUTHOR]

Background In this study, we present our experience with ureteral complications requiring revision surgery after renal transplantation and compare our results to a matched control population. Methods We performed a retrospective analysis of our database between 1997 and 2012. We divided the cases into early (<60 d) and late repairs. Kaplan-Meier and Cox proportional hazards models were used to compare graft survival between the intervention cohort and controls generated from the Scientific Registry of Transplant Recipients data set. Results Of 2671 kidney transplantations, 51 patients were identified as to having undergone 53 ureteral revision procedures; 43.4% of cases were performed within 60 d of the transplant and were all associated with urinary leaks, and 49% demonstrated ureteral stenosis. Reflux allograft pyelonephritis and ureterolithiasis were each the indication for intervention in 3.8%; 15.1% of the lesions were located at the anastomotic site, 37.7% in the distal segment, 7.5% in the middle segment, 5.7% proximal ureter, and 15.1% had a long segmental stenosis. In 18.9%, the location was not specified. Techniques used included ureterocystostomy (30.2%), ureteroureterostomy (34%), ureteropyelostomy (30.1%), pyeloileostomy (1.9%), and ureteroileostomy (3.8%). No difference in overall graft survival ( HR 1.24 95% CI 0.33-4.64, p = 0.7) was detected when compared to the matched control group. Conclusion Using a variety of techniques designed to re-establish effective urinary flow, we have been able to salvage a high percentage of these allografts. When performed by an experienced team, a ureteric complication does not significantly impact graft survival or function as compared to a matched control group. [ABSTRACT FROM AUTHOR]