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This case report shows the vital importance of vigilant observation of patients after transplant. In centers where ultrasonographs are not available, exploration of the patient may be necessary to salvage a precious kidney. In the patient reported here, who received a kidney transplant at St. Nicholas Hospital in Lagos (Nigeria, Africa), reexploration resulted in an increased area for the kidney, with both improved urine output and graft function.

A recent symposium and workshop in Khartoum, the capital of the Republic of Sudan, brought together broad expertise from three universities to address the current burden of communicable and non-communicable diseases facing the Sudanese healthcare system. These meetings identified common challenges that impact the burden of diseases in the country, most notably gaps in data and infrastructure which are essential to inform and deliver effective interventions. Non-communicable diseases, including obesity, type 2 diabetes, renal disease and cancer are increasing dramatically, contributing to multimorbidity. At the same time, progress against communicable diseases has been slow, and the burden of chronic and endemic infections remains considerable, with parasitic diseases (such as malaria, leishmaniasis and schistosomiasis) causing substantial morbidity and mortality. Antimicrobial resistance has become a major threat throughout the healthcare system, with an emerging impact on maternal, neonatal and paediatric populations. Meanwhile, malnutrition, micronutrient deficiency and poor perinatal outcomes remain common and contribute to a lifelong burden of disease. These challenges echo the United Nations (UN) sustainable development goals and concentrating on them in a unified strategy will be necessary to address the national burden of disease. At a time when the country is going through societal and political transition, we draw focus on the country and the need for resolution of its healthcare needs.

This paper relates to our transplant experiences in Third World countries. Over the years, I have started kidney transplant programs in Aden, Yemen and Abuja, Nigeria and restarted the transplant program in Khartoum, Sudan.

Autosomal dominant polycystic disease is a multisystem inherited condition affecting the kidneys and is an important cause of end-stage renal disease. Patients with autosomal dominant polycystic disease experience symptoms related to size and cystic nature of their kidneys, which can be difficult to manage. Traditionally, the only surgical option for management was open bilateral/unilateral native nephrectomy, which carried with it significant morbidity and mortality. Therefore, it was deemed unsafe and rarely performed. However, surgery for autosomal dominant polycystic disease has evolved rapidly with the advent of minimally invasive surgery and improved medical management of end-stage renal failure patients. Laparoscopic and hand-assisted laparoscopic techniques have been adopted and have demonstrated reduced morbidity. The timing of this intervention in relation to transplant is controversial and presents a major challenge in managing this patient population.

Advances in transplantation led to the first renal autotransplant in 1963 performed due to high ureteral injury sustained during aortic surgery. The procedure involves excision of the kidney and autologous re-implantation. Subsequently, multiple cases of renal autotransplantation have been reported in the literature for a range of indications. This reviews aims to assess the literature and experiences reported to assess the varying indications for renal autotransplant. The evidence and literature generated from experiences in this procedure are largely limited to case reports and relatively small or moderately sized case series. The main indications reported for performing autotransplant broadly includes renovascular disease, ureteral pathology and neoplastic disease. The advent of laparoscopic techniques and their implications on renal autotransplant also are discussed. Varying degrees of success are reported with this procedure with controversial issues surrounding this procedure remain, particularly in the area of neoplastic surgery. Renal autotransplant may be a useful last resort in preventing kidney loss in highly selected circumstances and when conventional methods have failed.

Elongation of the right renal vein with the inferior vena cava (caval patch) using a vascular stapler offers a safe means of extending the deceased-donor right renal vein, while minimizing the ischemic time of the kidney during preparatory dissection. The aortic patch of the right renal artery also can be preserved, which minimize the danger of arterial stenosis, kinking, and dissection.

We report a case of paratransplant hernia, a rare surgical complication of a renal transplant. It is caused by entrapment of the bowel through a defect in the peritoneum, which lines on the transplanted kidney. Careful dissection and meticulous surgical technique during transplant, closing any peritoneal defect, regardless of size, can avoid this complication. The prognosis depends on clinical suspicion, prompt diagnosis, and early surgical intervention. If strangulation occurs, the associated mortality is high.

To see if: (i) a large vessel aortocaval vascular patch technique may bring about long-term graft survival after allogeneic uterine transplantation (UTn) in a rabbit model; and (ii) fertility can be achieved following natural mating post-allogeneic UTn.Allogeneic uterine cross transplantations were performed in New Zealand white rabbits using an aortocaval macrovascular patch harvested as part of the uterine allograft. Five rabbit recipients received a uterine graft from five unrelated donor rabbits. All female rabbits were unrelated and were of proven fertility with at least one previous litter each. Tacrolimus was administrated for immunosuppression post-transplant. Natural mating was attempted if long-term survival had been achieved. The main outcome measures were: (i) long-term recipient survival; (ii) long-term adequate uterine perfusion; and (iii) successful pregnancy post-UTn.All five recipient animals survived the surgery with satisfactory immediate postoperative recovery. Recipients 1, 2 and 4 died within the first 4 postoperative days. Both long-term survivors failed to conceive following introduction of a proven male breeder despite evidence of mating. Necropsy at 9 and 11 months showed a lack of patency of uterine cornua at the point of anastomosis, albeit a small uterus in recipient 3 and a reddish brown amorphous material at the site of the transplanted uterus in recipient 5.We have demonstrated the feasibility of uterine allotransplantation using a macrovascular patch technique, but could not demonstrate conception because of blocked cornua. To address this, we propose using embryo transfer techniques in order to achieve conception.

After a kidney transplant, surveillance of the graft blood supply is crucial. Any delay in detecting compromised graft perfusion affects organ survival. Current practice uses Doppler ultrasound to monitor vessel patency and graft perfusion and is performed repeatedly after kidney and pancreas transplant. We have used an implantable probe that allows for easy vessel attachment and safe, continuous, audible monitoring of vascular anastomoses. It has been used to observe microvascular tissue transplants, free flaps, and pediatric liver transplants, but as yet, it has not been used to monitor kidney allografts. We feel a transplanted kidney could benefit greatly from continuous blood flow monitoring.To assess the feasibility of the probe in a renal transplant patient, we used the probe in 15 consecutive transplant recipients.Only 1 Doppler ultrasound was ordered during the 15 admissions compared with scans that are routinely ordered. There were no complications and all probes were removed easily.This probe can identify transplanted organs that are threatened owing to flagging or cessation of the blood supply, and allow for immediate intervention. This technique may save precious organs. Further controlled studies are needed to assess the use of the probe in routine clinical practice.

The aim of this article is to compare different mini-incision donor nephrectomy techniques in the literature.We did a literature search using PUBMED using the search term "donor nephrectomy." We compared different surgical techniques using different parameters like length of incision, length of operation, pain medications required after the operation, site of the operation, and intraoperative and postoperative complications.We found 7 different surgical techniques of mini-invasive donor nephrectomy. Hakim and associates described the smallest initial incision size of 4 cm. There also are limited data on the analgesia requirements in 4 of the series, and 3 series that describe the requirements vary.These techniques offer advantages and disadvantages to the donor and the kidney. We hope to encourage further work. Ideally, there must be a working discussion, long-term outcomes of donor kidney and recipient, as well as accurate pain records, both quantitative and qualitative, and a discussion of time to mobilization.

Simultaneous pancreas and kidney transplantation (SPK) is considered an extremely effective and well-established therapeutic option for selected patients with end-stage renal disease (ESRD), secondary to type 1 diabetes. Vascular complications in pancreas transplantation are more common than in any other solid organ transplant. Thrombosis is the most frequently observed surgical complication of pancreatic transplantation. We report a case of a successful management regarding the thrombosed distal pancreatic segment during SPK transplantation.

p53 protein promotes apoptosis, whereas Bcl-2 family proteins have an antiapoptotic function. This study determines the predictive value of selected clinical and histopathological factors in correlation with the expression of p53, Bcl-2, and Bcl-X(L) proteins in esophageal squamous cell carcinomas (SCCs). Paraffin-embedded sections from 19 surgically resected primary esophageal SCCs were examined by immunohistochemistry. p53 expression was related to degree of tumor differentiation (P = 0.044). Bcl-2 expression was associated with regional lymph node metastasis (P = 0.053), whereas Bcl-X(L) expression was correlated with distant metastasis (P = 0.060) and with the expression of Bcl-2 protein (P = 0.068). p53 and Bcl-2 family proteins may help to estimate the properties of esophageal SCCs and provide useful information to the oncologist for the selection of patients for intensive combined therapy modalities with curative intention or for palliative therapy.

Our knowledge regarding the biology of the gastroesophageal junction adenocarcinomas is still incomplete. Paraffin-embedded sections from 31 surgically resected primary cardia adenocarcinomas were examined by immunohistochemistry. Statistical analysis showed that Bcl-2 expression was significantly correlated with the age of the patients (P = 0.043), whereas Bcl-X(L) expression was inversely correlated with Bcl-2 expression (P = 0.021). An inverse correlation of high statistical significance was also found between p53 and Bcl-2 expression (P = 0.000). Fas expression was highly correlated with tumor stage (P = 0.006), degree of differentiation (P = 0.044), and the stage of the disease (P = 0.029). A significant correlation was also observed between the expression levels of WAF1 and Fas (P = 0.037), Fas and Bcl-X(L) (P = 0.018), and WAF1 and p53 (P = 0.018). These proteins may contribute to the estimation of the properties of adenocarcinomas of the gastroesophageal junction, facilitating prognosis of cancer patients treated by multimode therapy.

The Fas/FasL system plays an important role in the regulation of tumor apoptosis. This study examined the correlation between the expression levels of Fas and WAF1 with the clinicopathological characteristics of esophageal squamous cell carcinoma (SCC) tumors. Paraffin-embedded sections from 19 surgically resected primary esophageal squamous cell carcinomas were examined by immunohistochemistry. At low expression levels (5% to 24%), a 4-fold higher expression of Fas relative to WAF1 expression was observed. High expression levels (50% to 74%) of Fas were not recorded, whereas such levels of expression for WAF1 were retained in a proportion of cells20%. Proteins WAF1 and Fas were both expressed in all lesions of SCCs. Lesions showing high expression levels of WAF1 have a high degree of differentiation, but a sample that expresses WAF1 and belongs to the morphology I category probably has a medium degree of differentiation.

Severe organ shortage for transplantation is an increasing problem because the number of traditional heart-beating cadaveric donors is declining. Ways need to be found to expand the donor pool without commercializing organ transplantation, especially from unrelated live donors, and to maintain high medical standards of these procedures and their follow-up. Kidneys from asystolic or nonheart-beating donors (NHBDs) are a valuable source of organs, which can be of excellent quality, with good long-term function after transplantation. This organ source is widely underused at the moment; even so, there is increased popularity during the last few years in different countries. In addition, the rate of discarding viable kidneys from these NHBDs is still too high. Logistical and legal aspects are other important issues that need to be addressed to promote these NHBD programs more effectively. Waiting lists for renal transplantation could be significantly reduced in the future.

The experience obtained from the human hand allografts (HHA) performed to date suggests that the skin is a priviledged target of allograft rejection in this setting. The aim of this study was to establish a pathological score for assessing the severity of HHA rejection. The pathological slides of 89 skin biopsies obtained from the allografted limbs of six HHA recipients from day 0 to 5 years post-graft were retrospectively examined. According to the severity of the pathological changes observed, the following grades of rejection are proposed: 0: no rejection, I: mild rejection, II: moderate rejection, III: severe rejection, IV: very severe rejection. This grading system can be used as a basis for monitoring allograft rejection and for assessing the effects of the immunosuppressive treatment aiming at reversing HHA rejection; it can also be used for monitoring rejection of other skin-containing CTA.

Background There is no national policy for allocation of kidneys from Donation after circulatory death (DCD) donors in the UK. Allocation is geographical and based on individual/regional centre policies. We have evaluated the short term outcomes of paired kidneys from DCD donors subject to this allocation policy. Methods Retrospective analysis of paired renal transplants from DCD’s from 2002 to 2010 in London. Cold ischemia time (CIT), recipient risk factors, delayed graft function (DGF), 3 and 12 month creatinine) were compared. Results Complete data was available on 129 paired kidneys.115 pairs were transplanted in the same centre and 14 pairs transplanted in different centres. There was a significant increase in CIT in kidneys transplanted second when both kidneys were accepted by the same centre (15.5 ± 4.1 vs 20.5 ± 5.8 hrs p