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Introduction: Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center., Methods: Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas., Results: Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948)., Conclusion: Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival., (© 2022 S. Karger AG, Basel.)

Objectives: Late kidney transplant complication might compromise graft durability, thus the need for early detection and treatment., Material and Methods: A PubMed review including the following MeSH terms was included: kidney transplant¨, ¨complications¨, ¨vascular complications¨,¨transplant renal artery stenosis¨, ¨ureteral obstruction¨,¨urologic complications¨, ¨forgotten stent¨, ¨vesicoureteralreflux¨, ¨urinary lithiasis¨ e ¨incisional hernia¨. Metanalysis and systematic review in spanish and English were included from January 2015 till February 2021, as well as relevant selected manuscripts. RESULTS: We defined as late complications those appearing at 3 months from kidney transplant. Those include vascular complications (renal artery stricture), urinary tract (ureteral stricture, permanent double Js, pyelonephritis due to reflux, urinary stones) and abdominal wall (incisional hernia)., Conclusions: Late kidney transplant complications remain high still with advancement on surgical technique and immunotherapy. Those complication might compromise the graft durability and so early detection is or primary importance.

Purpose: To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants., Methods: Retrospective study of third renal transplants performed at our center. Outcomes were compared with a cohort of first and second transplants., Results: Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized [panel-reactive antibody (PRA) > 50%]. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%). Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants; p < 0.001), rejection (34.7% vs. 14.9% and 20.5%, p < 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%, p 0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively., Conclusion: Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.

Objective: Non-heartbeating donors (NHBD) are an alternative to heartbeating donors (HBD). Our objective was to compare functional results and kidney survival from NHBDs and HBDs., Material and Methods: A retrospective study comparing the results of 236 normothermically preserved kidneys from type i and ii type NHBDs with the results of 250 from HBDs that were transplanted in our center between 2005 and 2012. Homogeneity between groups was tested and we evaluated the presence of delayed graft function (DGF) associated with pretransplant variables of the donor and recipient., Results: Both groups show homogeneity in pretransplant characteristics in terms of: age, HLA incompatibilities, and recipient hemodialysis time. Average follow-up time was 33 months (range 0-87) for NHBDs and 38 months (range 0-90) for HBDs. 5.5% of NHBDs showed primary non-function (PNF) vs. 4% of HBDs (P=.42) and 80.9% of DGF vs. 46.8% of HBDs (P<.001). At the end of the follow-up, there were no statistically significant differences in the survival of grafts (92.8% for NHBD vs. 93.6% for HBD, P=.71) and recipients (99.1% NHBD vs. 98.6% HBD, P=.28)., Conclusions: Although the DGF percentage was greater for NHBDs, final creatinine as well as graft and recipient survival were similar for both groups. Therefore, in our experience, kidneys from NHBDs have similar results to those from HBDs and are an excellent source of organs for transplantation., (Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Our purpose was to review our kidney transplantation program based on the use of expanded criteria donors, and to determine current indications for dual kidney transplantation (DKT). In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation., Methods: In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. DKT were performed with donors >75 and donors between 60 and 74 years of age and glomerulosclerosis of >15%. The kidneys of donors between 60 and 74 years of age and with glomerulosclerosis of <15% were used for single kidney transplantation (SKT). In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics., Results: From 1996 to 2004, 222 SKTs and 88 DKTs were performed. Graft survival after 1 and 4 years was, respectively, 91% and 78% for SKT and 95% and 79% for DKT. In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. From 2005 to 2011, 328 SKT and 32 DKT were performed. During this period most kidneys used for DKT were from female donors >75 years old, weighing <65 kg, with a creatinine of >1 mg/dL and glomerulosclerosis of >15%. The recipients for DKT were mostly male, <70 years old and whose weight was >75 kg., Conclusion: DKT from expanded criteria donors shows good outcomes. However, in many cases SKT may fulfill the need of the recipient. The archetype for DKT is an older female weighing <65 kg and the most common recipient is an overweight male who is <70 years old., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: In 2005, our center started a donation after cardiac death (DACD) program, by which patients who present an irreversible cardiac arrest outside hospital are brought to our center with the purpose of organ donation. We reviewed the outcomes of our program of kidney transplants from DACD., Methods: We conducted a retrospective study of the DACD, and we reviewed the procedures carried out in our institution between July 2005 and December 2010 and descriptively analyzed the results obtained for kidney donation., Results: One hundred and fifty-two of 274 potential donors were transferred to our hospital. Of them, 126 (82.8%) were connected to cardiopulmonary bypass machine, and organs were procured in 113 donors (74.3%). The discarded grafts were mainly due to inadequate perfusion. One hundred and fifty-six kidneys were transplanted (51.3%). Over a median follow-up period of 18 ± 13.7 months, the median creatinine clearance was 78.2 ± 10.2 ml/min. 8.6% of the grafts had no primary function, and 85% had a delayed graft function. Recipient survival and graft survival were 98% and 87%, respectively., Conclusions: DACD is an adequate source of organs for kidney transplantation. Our functional and survival results are encouraged in the short term, although further work is required to increase the program's benefits., (© 2013 John Wiley & Sons A/S.)

Introduction: Between 1991 and 2006, the Latin American Dialysis and Renal Transplantation Registry collected data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay). Access to RRT was universal in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay, all countries belonging to the medium-high or high income group., Methods: Data about patients on renal replacement therapy (RRT) were supplied by national affiliates or the Registry's Coordination Committee. Transplant data were gathered and shared with the Latin American and Caribbean Society of Transplantation., Results: RRT prevalence increased from 162 patients per million population (pmp) in 1991 to 478 pmp in 2005 and 473 pmp in 2006 (59.2% hemodialysis, 20.4% peritoneal dialysis and 20.4% with a functioning kidney allograft). Countries with the highest prevalence were Puerto Rico (1,148.9 pmp), Uruguay (924.5 pmp) and Chile (907.6 pmp). Latin America's (LA) incidence increased from 27.8 pmp in 1992 to 188 pmp in 2006. The LA Kidney transplant rate increased from 3.7 pmp in 1987 to 15,4 pmp in 2006, and 166 combined transplants - kidney and another organ, mainly pancreas - were performed. In the medium-high income group 2006, (Argentina, Brazil, Chile, Costa Rica, Cuba, Mexico, Panama, Uruguay, Venezuela) the prevalence rate was 534.8 pmp vs. 289.5 pmp in the middle-low income group. The transplant rate was 18.4 pmp in the medium-high income group vs. 7 pmp in the middle-low group (p < 0.01)., Conclusions: RRT incidence and prevalence continue to grow steadily. Access to RRT is universal only in some countries included in the medium-high or high income group. It is imperative to accomplish the goal of making RRT available to all who need it.

Objective: To retrospectively evaluate the incidence of cardiovascular events after functioning simultaneous pancreas-kidney transplantation (SPKT)., Patients and Methods: Cardiovascular events after 89 SPKT procedures performed at our institution from March 1995 to March 2009 were investigated. Study criteria included normal functioning of both grafts. Patients included 36 women and 53 men, with mean (range) age of 37.7 (25-66) years. Duration of diabetes mellitus was 23.6 (10-48) years, and of dialysis therapy was 19.8 (0-70) months. The exocrine pancreatic secretions were drained to the bladder in 41 patients, and enterically in 45 patients. Mean (SD) follow-up was 58.62 (34.74) months., Results: During follow-up after SPKT, 9 patients (10.1%) experienced cardiovascular events including cerebrovascular accident in 4 patients, myocardial infarction (MI) in 3, and episodes of angina pectoris without evidence of coronary artery disease in 2 patients. Nevertheless, these two patients had sustained an MI that required coronary angioplasty before SPKT. Moreover, coronary angioplasty was required in 2 patients before they were enrolled in the transplantation program because of silent coronary artery disease. Four of 9 cardiovascular events occurred in the perioperative period. No deaths occurred due to cardiovascular events. Patient survival rate was 100%, with both grafts functioning in 87 (97.8%)., Conclusion: Cardiovascular events occur relatively frequently in patients undergoing SPKT. In the present study, most events occurred in the perioperative period, but did not result in death., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Introduction: In 2007 in Spain 43% of donors were older than 60 years. This produces a worse graft quality and probably a worse survival., Objective: Our objective is to analyze the influence of donor age on graft survival., Material and Methods: We analyze retrospectively 216 renal consecutive transplants realized between 2000 and 2008. A univaried and multivaried study (Cox regression) was performed and Kaplan-Meyer test with log rank for graft survival., Results: Follow-up mean of 40 months (+/-33,4 SD). The univaried analysis of graft survival showed that donor age had a significative influence on graft survival. (OR=1,03; 95% CI 1,01-1,05) (p: 0,009). Studying the relation between donor and recipient age we find an inverse correlation (Pearson's Correlation: 0,55. p<0,0001), but there are significative differences after the adjustment for recipient age. (OR: 1,02; 95% CI 1,01-1,04) (p: 0,04). Optimal cut-point value determined by the ROC analysis was 60 years. The graft survival of donors over 60 years is 79% (95% CI; 74-84%) and 71% (95% CI; 65-77%) at 3 and 5 years in contrast with 94% (95% CI; 94-96%) and 90% (95% CI; 88-92 in donors under 60. (p: 0,002). The multivaried study of the influential factors on graft survival reveals that donor age dichotomized in older or younger than 60, the presence of a surgical immediate reintervention and a delayed graft function were independent influence factors., Conclusions: Donor age over 60 years has a negative and independent prognostic influence on graft survival.

Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival., Materials and Methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graft survival., Results: At least one surgical complication occurred in 82 (38%) of the 216 transplantations, and 68 (31%) required some type of repeat surgery, 23 in the early postoperative period and 45 more than 3 months after surgery. Mean follow-up was 48 months (SD +/-33.4), and median follow-up 48 months (range, 0-166 months). No recipient or donor factors predisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3- and 5-year survival rates of 86% (95% CI 83-89) and 78% (95% CI 73-82) as compared to 92% (95% CI 90-94) and 88% (95% CI 85-91), p=0.004]. Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole group showed early repeat surgery to be a factor with an independent prognostic value (OR: 4.7; 95% CI 2.2-10, p<0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. CONCLUSION Surgical complications have an influence on graft survival. The need for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival.

Objective: We evaluated the incidence of urological complications after simultaneous renal and pancreatic transplantation., Patients and Methods: We retrospectively reviewed urological complications following 107 simultaneous kidney-pancreas transplantations performed at our institution between March 1995 and June 2008. The 46 women and 61 men were of mean age 37.8 years (range, 25-66). The mean duration of diabetes mellitus was 23.0 years (range, 9-48) and the mean duration of dialysis was 19.9 months (range, 0-70). The exocrine pancreatic secretions were drained to bladder in 58 cases, or enterically in 49 patients. The mean length of follow-up was 51.7 months., Results: The most frequent urological complication was urinary tract infection, reported in 63.8% of patients: 42 bladder-drained and 25 enteric-drained (P = .011). Hematuria occurred in 13 patients (12.5%): 12 bladder-drained and 1 enteric-drained (P = .002). Five bladder-drained patients developed bladder calculi. Among 58 bladder-drained patients, reflux pancreatitis occurred in 28 patients and urine leaks related to the pancreatic graft occurred in 7 patients. Conversion of exocrine secretions from bladder to enteric diversion was required in 6 patients. One- and 3-year patient survival rates were 92.7% and 89.1%, respectively. Moreover, 1 and 3-year kidney graft survival rates were 90.6% and 84.4%, and pancreas graft survival rates were 78.1 and 70.3%, respectively., Conclusion: Simultaneous kidney-pancreas transplantation with bladder drainage is associated with a high frequency of urological complications. Appropriate treatment can resolve most complications. In our opinion, both enteric and bladder drainage seemed to be safe and effective alternatives to manage pancreatic exocrine secretions.

Latin America, a region composed of a series of neighboring countries that share their history, Latin ancestry and language (Spanish or Portuguese), includes Mexico, Central America, the Spanish Caribbean islands, and South America. The Latin-American Dialysis and Kidney Transplantation Registry, which has been operative since 1991, collects data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay), where 97% of Latin Americans live. The prevalence of renal replacement therapy (RRT) has increased from 119 patients per million (pmp) in 1991 to 478.2 in 2005 (147,158 patients [57%] on chronic hemodialysis, 58,251 [23%] on peritoneal dialysis and 52,565 [20%] living with a functioning kidney graft). The incidence rate also increased from 27.8 pmp in 1992 to 167 in 2005. The increment in prevalence and incidence occurred in all Latin- American countries. The transplantation rate increased from 3,7 pmp in 1987 to 15 pmp in 2005 (7,968 kidney transplants performed this year, the cumulative number being 98,415). Access to RRT was available for every patient diagnosed with end-stage renal disease only in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay. In Latin America, the incidence and prevalence of RRT increased year by year. Only in some countries is access to RRT available to 100% of diagnosed patients. Detection and prevention programs for chronic kidney disease are needed in the region. Meanwhile, access to RRT has to be improved for everybody who needs it.

Objective: The aim of this paper is to identify the variables that could be of interest in the outcome of a series of cadaveric kidney transplantation performed at the University Hospital, Navarra School of Medicine, by means of multifactorial and multivariate statistical analyses., Method: We analyzed 307 cadaveric kidney transplantation performed since 1976 at the University Hospital, School of Medicine, University of Navarra. Two series are included: the historical and the actual. The former did not include cyclosporine A in the immunosuppressor protocol., Results: The first step was to compare survival in both series. The cyclosporine A series had a better survival, which was statistically significant (p < 0.0001). The prognostic factors in both series were also analyzed. The influence of the different variables were studied in the survival distribution. The worse prognostic variables of the historical group on allograft survival were donor's age (particularly between 20 and 50 years old), delayed graft function, serum creatinine level greater than 2.5 mg/dl at the first month following transplantation, general surgical complications, and vascular and other complications. In the actual group, the allografts with the worst survival were in those that received 4-10 pre-transplant blood transfusions, those with more that 2 HLA-DR mismatches, the hyperimmunized receptors with a level of pre-formed cytotoxic antibodies greater than 50%, those who rejected the allograft in the initial post-transplant period, those with a serum creatinine level greater than 2.5 mg/dl and those who presented surgical complications in general and urinary and vascular complications in particular., Conclusions: The multivariate analysis reveals that the prognostic factors of the historical group were delayed graft function, surgical complications, HLA A+B mismatches and the donor's age. In the actual group, the factors were receptor's age, surgical complications, large ischemia time, peak reactive antibody and number of rejections.