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Este artículo reseña: G. Moreno Cordero. Validez de las resoluciones civiles y canónicas sobre crisis matrimoniales entre España y Colombia: una visión renovada. Aranzadi, Cizur Menor (Navarra), 2022, 336 pp.

El presente estudio persigue desvelar las claves de determinación de la ley aplicable a los contratos internacionales en la historia. Desde la Antigüedad y la Alta Edad Media hasta el siglo XXI. Se analizan las conexiones como el lugar de celebración del contrato, el lugar de cumplimiento de las obligaciones derivadas del contrato, la elección de la ley aplicable, la residencia habitual del contratante que debe realizar la prestación característica y la cláusula de los vínculos más estrechos. En dicho estudio, se exponen las aportaciones de grandes juristas del Derecho internacional privado, como Bartholo da Sassoferrato, Rochus Curtius, Charles Dumoulin, F.k. Von Savigny y especialmente Jacobo de las Leyes. Este trabajo sostiene, contra la visión marxista de la historia del Derecho, que el progreso del Derecho internacional privado se debe a personas, con nombres y apellidos, auténticos genios del Derecho Internacional privado.

Este artículo reseña: Franco Mosconi / Cristina Campiglio. Diritto internazionale privato e processuale, vol. 1, Parte generale e obbligazioni, 10ª ed., Utet Giuridica, Manuali universitari, Milano, 2022, 608 pp. ISBN: 8859824923

Este artículo reseña: Nuria Marchal Escalona. El divorcio no judicial en Derecho internacional privado español, Editorial Aranzadi, Navarra, 2022, 214 pp. ISBN 9788411249089

El Reglamento Roma III (Reglamento 1259/2010 del Consejo, de 20 de diciembre de 2010, por el que se establece una cooperación reforzada en el ámbito de la ley aplicable al divorcio y a la separación judicial) contiene un nuevo conjunto de normas en la materia. El primer punto de conexión para determinar la ley aplicable al divorcio es la autonomía conflictual de las partes. El divorcio se rige por la ley elegida por las partes. Este criterio es eficiente. La autonomía de las partes conduce a la ley que comporta los menores costes de litigación para los cónyuges. De este modo, el divorcio se concederá de acuerdo con las expectativas de las partes. El acuerdo la ley aplicable es también un contrato. En consecuencia, algunas normas regulan la capacidad jurídica, el consentimiento y la validez formal del acuerdo. Este trabajo aborda los requisitos de este acuerdo y demuestra que el legislador europeo considera que la autonomía de la voluntad proporciona soluciones eficientes a los conflictos de leyes incluso por encima del punto de conexión de la residencia habitual de los cónyuges. Es un signo de libertad permitir que los cónyuges puedan escoger la Ley aplicable a su divorcio.

Sin resumen

Este artículo reseña: P. Franzina. Introduzione al diritto internazionale privato. Giappichelli Editore,Torino, 2021, 336 pp. ISBN 9788892142237

Bibliografía

Este trabajo analiza la sentencia del TJUE de 3 junio 2021, C-280/20, ZN vs. Generalno konsulstvo na Republika Bulgaria v grad Valensia, Kralstvo Ispania y a través de dicho estudio, pone de relieve que el Reglamento Bruselas I-bis debe aplicarse a todo litigio internacional en materia civil y mercantil suscitado ante los tribunales de los Estados miembros de la UE. En tal sentido, el TJUE distingue entre “situación jurídica” y “litigio”. Indica el TJUE que un litigio es transfronterizo o internacional si en el mismo está presente un elemento extranjero, cualquiera que sea su naturaleza, su importancia objetiva y su intensidad. Con ello el TJUE potencia el efecto útil del Reglamento Bruselas I-bis.

Resumen Objetivo Evaluar la seguridad y eficacia de la tecnica de control de la vena cava inferior retrohepatica por acceso anterior (RIVCA, por retrohepatic inferior vena cava control through an anterior approach) en el carcinoma de celulas renales (CCR) con trombo tumoral nivel iii a. Pacientes y metodos Serie inicial de 6 casos que presentan CCR con trombo tumoral nivel iii a intervenidos de nefrectomia radical y trombectomia tumoral mediante la tecnica RIVCA entre 2018-2019. El objetivo de la tecnica RIVCA es obtener un control completo de la vena cava inferior retrohepatica por encima de la porcion craneal del trombo tumoral, pero excluyendo las venas hepaticas mayores con el fin de preservar la circulacion hepatocava natural. Se proporciona la descripcion paso a paso del procedimiento. Se registraron prospectivamente los rasgos de la enfermedad, asi como las caracteristicas y los resultados quirurgicos. Resultados La nefrectomia radical y la trombectomia tumoral se completaron en todos los casos. La tecnica RIVCA no aumento significativamente el tiempo quirurgico (rango: 14-22 min). La media de sangrado estimado fue de 325 cc (rango: 250-400). No se requirio transfusion de sangre intraoperatoria en ningun caso. La media de unidades de concentrados de hematies transfundidos por paciente en el periodo postoperatorio fue de 1,3 (rango: 0-2). No hubo casos de embolia pulmonar intraoperatoria ni se produjeron complicaciones mayores (Clavien-Dindo III-V) en el periodo postoperatorio a 30 dias. La estancia hospitalaria postoperatoria (mediana) fue de 8 dias (rango: 5-11). Conclusiones La tecnica RIVCA aplicada a los casos de CCR y trombo tumoral nivel iii a proporciona un control completo de la vena cava inferior retrohepatica por encima de la porcion craneal del trombo tumoral, a la vez que evita la inestabilidad hemodinamica intraoperatoria al mantener la precarga cardiaca a traves del circuito portocava. Esta tecnica puede limitar la morbilidad operatoria (embolia pulmonar intraoperatoria y hemorragia masiva), convirtiendose asi en un complemento de gran utilidad en casos de CCR con trombo tumoral de nivel iii a.

Este artículo reseña: Jürgen Basedow. EU Private Law: Anatomy of a Growing Legal Order. Cambridge, Intersentia, 2021, cxxvii + 785 p. ISBN: 978-1-83970-121-4.

espanolEl presente trabajo constituye una reflexion sobre las lineas basicas de la ensenanza del Derecho internacional privado en el contexto liquido de la sociedad del siglo XXI. El docente de Derecho internacional privado debe asumir que esta disciplina se entiende mejor cuando se expone de manera sencilla y directa. Debe tambien estar preparado para explicar las paradojas juridicas aparentes del Derecho internacional privado y asumir que es necesario estudiar otras ramas del Derecho antes de comenzar a reflexionar sobre el Derecho internacional privado. En tal sentido, el Derecho internacional privado se ensena mejor a traves de sus problemas abiertos o nudos problematicos de Derecho internacional privado. Del mismo modo, la ensenanza del Derecho internacional privado consigue motivar a los estudiantes si se transmite la vision de un Derecho internacional privado que logra resultados justos, que mueve los corazones de las personas y que constituye un discurso intelectual y esteticamente bello. EnglishThis essay is a reflection on the basic lines of the teaching of private international law in the liquid context of 21st century society. Teachers of private international law must assume that the discipline is best understood when it is presented in a simple and straightforward manner. He or she must also be prepared to explain the apparent legal paradoxes of private international law and to accept that it is necessary to study other branches of law before beginning to reflect on private international law. Private international law is best taught through its open problems. Similarly, the teaching of private international law can motivate students if it conveys the vision of a private international law that achieves fair results, that moves people’s hearts and that operates as an intellectually and aesthetically beautiful discourse.

Bibliografia

espanolEste trabajo expone la actual regulacion juridica de la promesa de matrimonio en Derecho internacional privado. Tras un analisis de las muy abundantes y profundas polemicas sobre la naturaleza juridica de esta curiosa institucion, el presente trabajo desvela que la ruptura de la promesa de matrimonio genera obligaciones extracontractuales. De ese modo, se explica la aplicacion del Reglamento Bruselas I-bis para concretar los tribunales competentes y la aplicacion del Reglamento Roma II para precisar la Ley aplicable al fondo de la cuestion. En dicho analisis emerge cono solucion optima para la mayor parte de los casos la aplicacion de la Ley del pais de la residencia habitual de la victima, que es la ley del pais donde se ha verificado el dano mayor. EnglishThis essay deals with the legal regulation of the promise of marriage today in cases involving foreign elements. After an analysis of the very deep controversies about the legal essence of this curious institution, the present work reveals that the breaking of the promise to marry generates extra-contractual obligations. Accordingly, the Brussels I-bis regulation is to be applied in order to specify the courts hearing the case. In addition to that, the Rome II regulation must be applied to specify the Law applicable to the substance of the matter. In this perspective, not only should the bulk of the damage be localized in the country where the victim has his/her habitual residence but also, in accordance with that, the application of the law of the country of habitual residence of the victim emerge as the optimal and more efficient solution for most cases.

OBJECTIVE To describe a series of 3 cases of renal cell carcinoma that developed a metachronic recurrence in the form of inferior vena cava tumor thrombus after a first attempt of curative intent by means of radical nephrectomy. METHODS A complete work-up consisting of total body computed tomography and transesophagic echocardiography was performed in all cases. After extensive counseling a decision for surgical excision was made. We used a transplant-based approach to eliminate every vestige of visible neoplastic tissue including the tumor thrombus in all cases. Three different approaches, including tangential and circumferencial excision of the inferior vena cava with or without caval replacement by prosthetic vascular graft were used for caval management after thrombectomy. RESULTS Estimated blood loss ranged between 500 and 2000 cc. Transfusion requirements varied from 1-9 red blood cell packed units. Complete thrombectomy along with excision of all visible neoplastic lesions was achieved in all cases. One of the patients experimented a cardiac arrest on postoperative day 7 without fatal consequences that increased de length of stay (range 7-30 days). No other major complications were registered. None of the patients died in the first 30 days after the procedure. CONCLUSION The transplant-based surgical approach to thrombectomy in these cases provides for excellent exposure and vascular control, thus minimizing the complication rate and resulting a safe treatment option for the patient.

Renal cell carcinoma is no longer considered a monolithic disease, but a group of different entities exhibiting unique molecular alterations requiring a tailored systemic approach. One of the remaining challenges is the identification of the best candidate for a particular therapeutic regimen.: Current literature regarding the recent advances and treatment options in systemic therapy for metastatic RCC, and issues pertaining to the available biomarkers tested to date for a correct treatment stratification.: Underlying biology of RCC will still drive the development of new treatment agents/combinations that will be tested in earlier stages of the disease, and probably prove to have a role in the neoadjuvant/adjuvant settings. The correct characterization of the tumor microenvironment through transcriptomic analysis should help to overcome the issues related to tumor heterogeneity. Preclinical ex-vivo models will enlarge our current knowledge regarding the potential immune-escape mechanisms exhibited by RCC, and facilitate a better monitoring of the response to therapy. New tracers, image modalities, and tests aimed at detecting and analyzing tumor-circulating cells will improve our clinical performance through a better identification of the metastatic site locations and their variable histologic patterns, and ultimately their behavior in response to treatment.

Este artículo reseña: Mª Victoria Cuartero Rubio y José Manuel Velasco Retamosa (Directores). La vida familiar internacional en una Europa compleja: cuestiones abiertas y problemas de la práctica. Tirant lo Blanch, 1ª Edición, 424 págs. ISBN 9788411132978.

Este artículo reseña: María José Azaustre Fernández. Determinación de la residencia habitual y foros de competencia: del Derecho romano al Reglamento europeo de sucesiones. Editorial Aranzadi, Navarra, ISBN 9788413455099, 2021

Background Transplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications. Patients and methods We performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient. Results No post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation. Conclusions Vascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants.

Resumen Antecedentes El trasplante renal con variantes anatomicas vasculares sigue siendo un desafio. Debido a su exito variable en lo que respecta a la funcion del injerto despues del trasplante, estos organos se descartan frecuentemente, asumiendo de antemano una tasa inasequible de complicaciones vasculares. Pacientes y metodos Realizamos 3 trasplantes de rinon utilizando organos de donantes fallecidos que presentaban variantes vasculares (arterias multiples y venas cortas), incluyendo un rinon en herradura indivisible. Se utilizaron diferentes injertos extraidos de la aorta, la arteria iliaca comun y la vena cava inferior del mismo donante para reconstruir la configuracion vascular inicial mediante la creacion de conductos arteriales y venosos individuales, con el fin de simplificar la anastomosis vascular en el receptor. Resultados No se registraron complicaciones postoperatorias. Los tiempos de isquemia caliente fueron comparables con los de aloinjertos renales de una sola arteria. En ningun caso se observo un retraso en la funcion del injerto y todos los pacientes recuperaron la funcion renal normal despues del trasplante. Conclusiones La reconstruccion vascular mediante injertos arteriales y venosos del mismo donante fallecido puede ser un recurso util para simplificar la anastomosis vascular durante la cirugia de trasplante, evitando asi su descarte de antemano, reduciendo al minimo las complicaciones perioperatorias y permitiendo tasas normales de funcion de los injertos en el seguimiento a largo plazo. El resultado satisfactorio obtenido mediante la utilizacion de este enfoque ayudaria a ampliar los criterios de donantes para incluir organos que presentan variantes anatomicas vasculares.

Introduction The complications associated to the placement of the reservoir are infrequent but potentially serious. Therefore, technical alternatives have been developed for the performance of the procedure in different locations (ectopic). The aim of this review is to revise the evidence available on the different options for the ectopic placement of the reservoir. Material and method Narrative review based on a bibliographical search limited to PubMed-indexed relevant manuscripts, in Spanish or English, for the period 2000–2019, using “penile prosthesis”, “ectopic reservoir”, radical prostatectomy”, “radical cystectomy”, “pelvic radiotherapy”, and “renal transplantation” as key words. Non original articles and reviews were not considered eligible. A total of 11 manuscripts were included. Results Pelvic alterations after surgery and/or radiotherapy increase the difficulty in the placement of the prosthesis reservoir. In order to minimize the risk of complications, different modifications have been performed on the devices, and technical innovations have been developed for the submuscular placement of the reservoir. The available evidence regarding the functionality and complications of these techniques is limited to single institution, low volume, and retrospective series with short follow-up periods. The functionality seems to be adequate using the adapted devices. The complications are infrequent and mild in severity. Conclusions Although the available evidence is still limited, the ectopic placement of the reservoir may be considered a safe, effective, and reproducible technique. In addition, it may result particularly useful in cases of altered pelvic anatomy.

Resumen Introduccion Las complicaciones asociadas al emplazamiento del reservorio son infrecuentes pero pueden ser potencialmente graves, motivo por el cual se han desarrollado alternativas tecnicas para el emplazamiento en lugares diferentes al habitual (ectopico). El objetivo de este trabajo es revisar, de acuerdo con la evidencia disponible, las diferentes opciones para el emplazamiento ectopico del reservorio. Material y metodo Revision narrativa basada en una busqueda bibliografica de articulos relevantes indexados en PubMed, en ingles o castellano, publicados en el periodo 2000-2019, empleando las palabras clave: «protesis de pene», «reservorio ectopico», «prostatectomia radical», «cistectomia radical», «radioterapia pelvica» y «trasplante renal». Se descartaron los articulos no originales, casos aislados y revisiones. Se revisaron un total de 11 trabajos. Resultados Las alteraciones de la anatomia de la pelvis tras cirugia o radioterapia generan una dificultad anadida al emplazamiento del reservorio. Para minimizar el riesgo de complicaciones se han modificado los dispositivos y las tecnicas que permiten el emplazamiento submuscular. La evidencia relativa a funcionalidad y complicaciones se limita a series retrospectivas, de instituciones unicas, bajo volumen y escaso seguimiento. La funcionalidad es adecuada con los dispositivos adaptados; las complicaciones, infrecuentes y de escasa gravedad. Conclusiones Aunque la evidencia es baja, el emplazamiento ectopico del reservorio puede considerarse una tecnica segura, eficaz y reproducible. Ademas, puede resultar particularmente util en casos de anatomia pelvica alterada.

Este artículo reseña: Fabrizio Marrella, Manuale di Diritto. Del commercio internazionale. SecondaEdizione, Cedam, Milano, 2020, 936 pp. ISBN 9788813373672

RENDO, Carmen López; AZAUSTRE, María José. Sumisión y residencia habitual en el Reglamento europeo de sucesiones: fundamentos romanísticos. Revista Internacional de Derecho Romano, nº 24, abr. 2020. Disponible en: http://www.ridrom.uclm.es/documentos24/lopez24.pdf

Atherosclerosis is common in patients with end-stage renal disease. Severe calcification of the iliac vessels is expected in the growing pool of kidney transplant candidates. Thus, transplant surgeons must constantly develop alternative operative strategies to deal with the technical challenges that this condition confers. This case report aims to highlight a reconstructive vascular technique to salvage a completely calcified recipient external iliac artery using a deceased donor's arterial iliac allograft from the same donor as the renal allograft in a 59-year-old man, as an effective method to decrease vascular complications. Keywords: Kidney transplantation, Vascular complications, Surgical technique, Arterial allograft, Arterial reconstruction, Atherosclerosis

Background Renal cell carcinoma (RCC) with tumor thrombus extending into the inferior vena cava (IVC) occurs in 4%-10% of cases. Within this subset, pulmonary tumor embolism (PTE) appears in approximately 0.9%-2.4% of cases. We wanted to review our experience in managing patients with RCC with IVC involvement and a preoperative diagnosis of PTE. Methods A total of seven patients presented at our center between January, 2005 and January, 2015 with RCC, IVC involvement, and PTE (diagnosed either by chest computerized tomography angiography or preoperative transesophageal echocardiogram). Each patient underwent a radical nephrectomy and tumor thrombectomy using an organ transplant-based approach. Results Surgical removal of the PTE was performed in three patients (tumor embolectomy in two cases, right lower lobe resection in one case); the PTEs in four patients were considered to be too small to undergo surgical resection. PTE pathology found neoplastic cells in each patient that had surgical removal. No postoperative complications were observed in any of the seven patients. All four patients who were metastasis-free preoperatively (with 2/4 having tumor embolectomy performed) developed distant metastasis; median time-to-developing metastatic disease was 6.5 months. With a median follow-up of 19 months, three deaths because the disease have occurred. Conclusion Although RCC with IVC tumor thrombus complicated by PTE may not be catastrophic in most cases, it appears to be associated with an increased risk of developing metastatic disease. In addition, as the PTEs appear to contain neoplastic cells, pulmonary artery embolectomy at the time of nephrectomy should be performed whenever possible.

Highlights • Surgical planning based on preoperative CTA is necessary in patients with vascular anomalies in order to avoid complications. • Intrabdominal adhesions are common in patients with previous abdominal surgery and can affect the surgical approach for donor nephrectomy. • Considering the extension of the donor eligibility criteria, it is expected to see cases with congenital vascular anomalies., Introduction The extension of donor eligibility criteria represents one of the possible ways to increase the organ shortage, thus decreasing the waiting time for kidney transplantation. Expectedly, this strategy is associated with a growing number of more technically demanding living donor nephrectomy procedures requiring careful assessment, and sound surgical experience in order to avoid intraoperative complications. Case presentation After a thorough evaluation through preoperative imaging, we performed a hand-assisted left laparoscopic living donor nephrectomy in a 56 year-old overweight patient with history of prior abdominal surgery, harboring a left-sided inferior vena cava (IVC). Discussion/conclusion This case describes our comprehensive approach in this complex surgical scenario to preserve donor safety and provide an optimal kidney graft.

Patient: Male, 30-year-old Final Diagnosis: End stage renal disease secondary to hypertensive nephropathy Symptoms: Uremic symptoms Medication:— Clinical Procedure: — Specialty: Transplantology Objective: Rare disease Background: En bloc pediatric kidneys (EBPK) are one potential solution to increase the number of organs available in the donor community, thus promoting transplantation of these allografts into adult recipients. However, EBPK transplantation has been traditionally considered suboptimal due to concerns for perioperative complications, mainly vascular thrombosis. We report an en bloc kidney transplantation using vascular grafts from another deceased donor to extend the EBPK aorta and vena cava and create a tension-free anastomosis with recipient external iliac vessels. Case Report: A pair of 2-month-old female en bloc kidneys weighting 6 kg were transplanted to a 30-year-old adult male. Prolonged cold ischemic time (CIT) was related to high refusal rate and long travel from Nevada to Miami. Prior to transplantation, the EBPK were connected to the LifePort Renal Preservation Machine® and deemed transplantable only after showing a significant improvement in perfusion parameters. Back-table reconstruction was conducted through an end-to-end anastomosis between an adult deceased donor common iliac artery and vein grafts to the inferior vena cava and aortic distal ends, respectively. The patient displayed immediate graft function (IGF) without any postoperative complications, showing a creatinine of 1.5 mg/dl at 4-month follow-up. Conclusions: Use of renal preservation machine (RPM) and refined back-table reconstruction of these allografts are important tools to improve the significant discard rate and improve outcomes of EBPK.

Objective To evaluate the safety and efficacy of the retrohepatic inferior vena cava control through an anterior approach (RIVCA) technique in renal cell carcinoma (RCC) with level IIIa tumor thrombus. Patients and methods Initial series of 6 cases presenting RCC and level IIIa tumor thrombus who underwent radical nephrectomy and tumor thrombectomy using the RIVCA technique between 2018–2019. RIVCA technique aims to gain complete control of the retrohepatic inferior vena cava above the cranial end of the tumor thrombus, but excluding the major hepatic veins in order to preserve the natural hepato-caval shunt. A step-by-step description of the procedure is provided. Disease features, operative characteristics, and surgical outcomes were registered prospectively. Results Radical nephrectomy and tumor thrombectomy were completed in all cases. RIVCA technique did not increase operative time significantly (range: 14–22 min). Mean estimated blood loss was 325 cc (range: 250–400). Blood transfusion was not required intraoperatively in any of the cases. Mean postoperative transfusion rate was 1.3 red blood cells packed units (range: 0–2). There were no cases of intraoperative pulmonary embolism or major complications (Clavien-Dindo III-V) in the period of 30 days postoperatively. Median postoperative length of stay was 8 days (range: 5–11). Conclusions The RIVCA technique applied to cases of RCC and level IIIa tumor thrombus provides complete control of the retrohepatic inferior vena cava above the tumor thrombus cranial end, while prevents intraoperative hemodynamic instability by maintaining cardiac preload through the porto-caval shunt. This technique may limit operative morbidity (intraoperative pulmonary embolism and massive hemorrhage), thus becoming a helpful adjunct to be used in cases of RCC with level IIIa tumor thrombus.

Simple Summary Renal cell carcinoma rarely invades the surrounding visceral structures. While surgical extirpation has been the mainstay of treatment for the localized disease, the role of surgery in cases of venous involvement, adjacent invasion or distant metastasis remains controversial. Furthermore, the surgical option may represent a challenge. A large series of locally advanced renal cancer with involvement of the liver, pancreas, and/or duodenum, sometimes in conjunction with tumor thrombus extending inside the inferior vena cava is herein reported. Our series establishes the technical feasibility of this complex surgical procedure with acceptable complication rates, no perioperative death, and potential for durable response. With the use of new systemic therapy schedules, these patients will probably have a better opportunity of survival extension. Abstract Background: The purpose of this study is to report the outcomes of a series of patients with locally advanced renal cell carcinoma (RCC) who underwent radical nephrectomy, tumor thrombectomy, and visceral resection. Patients and methods: 18 consecutive patients who underwent surgical treatment in the period 2003-2019 were included. Neoplastic extension was found extending into the pancreas, duodenum, and liver in 9(50%), 2(11.1%), and 7(38.8%) patients, respectively. Seven patients (38.8%) presented also inferior vena cava tumor thrombus level I (n = 3), II (n = 2), or III (n = 2). The resection was tailored according to the degree of invasiveness. Demographics, clinical presentation, disease characteristics, surgical details, 30-day postoperative complications, and overall survival (OS) were analyzed. Results: Median age was 56 years (range: 40–76). Median tumor size was 14.5 cm (range, 8.8–22), and 10 cm (range: 4–15) for those cases with pancreatico-duodenal and liver involvement, respectively. Median estimated blood loss (EBL) was 475 mL (range: 100–4000) and resulted higher for those cases requiring thrombectomy (300 mL vs. 750 mL). Nine patients (50%) required transfusions with a median requirement of 4 units (range: 2–8). No perioperative deaths were registered in the first 30 days. Overall complication rate was 44.4%. Major complications were detected in 6/18 patients (33.3%). Overall median follow-up was 24 months (range: 0–108). Five-year OS (actuarial) rate was 89.9% and 75%, for 9/11 patients with pancreatico-duodenal involvement and 6/7 patients with liver invasion, respectively. Conclusion: Our series establishes the technical feasibility of this procedure with acceptable complication rates, no deaths, and potential for durable response.

Objective: The aim of the study was to describe our experience in patients who underwent nephron-sparing surgery (NSS) with tumor thrombectomy. Patients and Methods: Three consecutive patients who underwent NSS and tumor thrombectomy for localized single/multifocal renal cell carcinomas (RCCs) in conjunction with tumor thrombus between 2007 and 2011 were included. Open partial nephrectomy and thrombectomy was performed. Reconstruction included main renal vein, collecting system, and remaining parenchymal closure. One of the cases required additional artery repair and flushing with preservation solution. Results: Ischemic time was kept for 30–40 min. Mean estimated blood loss was 183.3 cc (range:100–300). One patient required the transfusion of 1 packed red blood cells unit. One of the patients developed a urinary fistula requiring double-J stenting. Hospital staying ranged between 5 and 8 days. None of the patients required renal replacement therapy either postoperatively or in the follow-up. Serum creatinine level at last follow-up (mean 83 months) ranged from 0.8 to 2.8 mg/dL. Conclusion: Our experience supports the feasibility of imperative partial nephrectomy and tumor thrombectomy for cases of RCC with renal vein involvement by tumor thrombus. In experienced hands, this approach may offer the patient a low morbidity postoperative course and long-term freedom from disease while maintaining the renal function, thus avoiding the need of renal replacement therapy.

Urologic complications can still occur following kidney transplantation, sometimes requiring multiple radiological and/or surgical procedures to fully correct the problem. Previously proposed extravesical ureteral reimplantation techniques still carry non-negligible risks of the patient developing urologic complications. About 10 years ago, a new set of modifications to the Lich-Gregoir technique was developed at our center, with the goal of further minimizing the occurrence of urologic complications, and without the need for initial ureteral stent placement. It was believed that an improvement in the surgical technique to minimize the risk of developing urologic complications was possible without the need for stent placement at the time of transplant. In this report, we describe the advantages of this technique (i.e., mobilized bladder, longer spatulation of the ureter, inclusion of bladder mucosa with detrusor muscle layer in the ureteral anastomosis, and use of a right angle clamp in the ureteral orifice to ensure that it does not become stenosed). We also retrospectively report our experience in using this technique among 500 consecutive (prospectively followed) kidney transplant recipients transplanted at our center since 2014. During the first 12mo post-transplant, only 1.4%(7/500) of patients developed a urologic complication; additionally, only 1.0%(5/500) required surgical repair of their original ureteroneocystostomy. Five patients(1.0%) developed a urinary leak, with 3/5 having distal ureteral necrosis, and 1/5 subsequently developing a ureteral stricture. Two other patients developed ureteral stenosis, one due to stricture and one due to ureteral stones. These overall results are excellent when compared with other reports in the literature, especially those in which routine stenting was performed. In summary, we believe that the advantages in using this modified extravesical ureteroneocystostomy technique clearly help in lowering the early post-transplant risk of developing urologic complications. Importantly, these results were achieved without the need for ureteral stent placement at the time of transplant.

Background We describe the safety and efficacy of performing pediatric kidney transplantation with a modified extraperitoneal approach that includes mobilization of the native liver and kidney. Methods We retrospectively identified pediatric renal transplants performed using this technique between 2015 and 2019. Data on patient demographics, surgical technique, and intraoperative details were collected. Outcomes were measured by morbidity and re-operation at 90 days, as well as serum creatinine, allograft survival, and overall survival at 1 year. Results Twenty-one patients with a median age of 5 (IQR 3–9) years, weighing 17.5 (IQR 14.5–24) kg were included. Median donor age was 24 (IQR 19–31) years. No intraoperative complications occurred. One child required a right native nephrectomy to allow sufficient space. Postoperatively, all patients had immediate graft function without urine leak or allograft thrombosis. 90-day morbidity and re-operation rates were zero. Both 1-year allograft and overall survival were 100% (on follow-up of all 21 patients through 1 year post-transplant), with a median serum creatinine of 0.58 (IQR 0.47–0.70) mg/dl at 1 year post-transplant. Conclusions Pediatric kidney transplantation of adult renal allografts using an extraperitoneal approach with native liver and kidney mobilization has promising allograft and patient survival outcomes that eliminates peritoneal violation and may diminish the need for native nephrectomy.

Introduction: little is known on the risk factors, clinical presentation, therapeutic protocols, and outcomes of kidney transplantation recipients (KTRs) who become infected by SARS-CoV-2. Purpose: to provide an updated view regarding the early experience obtained from the management of KTRs with COVID-19. Materials and Methods: A narrative review was conducted using PubMed database to identify relevant articles written in English/Spanish, and published through May 15, 2020. Search terms included: “coronavirus”, “severe acute respiratory syndrome coronavirus 2”, “SARS-CoV-2”, “COVID-19”, “COVID”, “renal transplantation”, and “kidney transplantation”. Case series were considered eligible, and case reports excluded. Thirty-four articles were included in the review. Results: KTRs should be considered immunocompromised hosts: potential risk for infection, non-negligible comorbidity, and exposure to long-term immunosuppression. Only single center small retrospective experiences are still available regarding KTRs with COVID-19. SARS-CoV-2 symptoms in KTRs are similar to that observed for the general population, being fever and cough the most frequently observed. Mild-to-moderate symptomatic KTRs can be managed in an outpatient setting, while patients exhibiting severe symptoms must be addmited to hospital. More rapid clinical progression, and higher complication and death rates have been observed for hospitalized KTRs, requiring hemodyalisis or ventilatory support. Lymphopenia, elevated serum markers (C-reactive protein, procalcitonin, IL-6, D-dimer), and chest-X-ray findings consistent with pneumonia are linked to worse prognosis. A number of antiviral therapies have been used. However, it is difficult to draw meaningful conclusions regarding their efficacy at this point. Baseline immunosupression regimen should be adjusted in a case-by-case manner. However, it poses a significant challenge.