Introduction:Transplant renal artery stenosis (TRAS) is a well-known vascular complication of renal transplantation. The aim of this analysis was to assess the short and midterm outcomes of endovascular therapy to salvage transplant kidney.Methods:We retrospectively analyzed our transplant database from 2000 to 2015. Percutaneous transluminal angioplasty/stenting was done in 24 patients (22 men and two women) with significant TRAS. The mean age was 59 ± 12 years. The parameters analyzed were: Technical success, pre- and post-treatment serum creatinine and number of antihypertensive drugs before and after treatment and vessel patency on Doppler ultrasonography at 3 and 6 months.Results:Overall incidence of TRAS in this study was 5.06%. Incidence of TRAS following live donor transplantation was 4.68% while that in deceased donors was 11.5%. Technical success was 100%. There were no periprocedural deaths. Renal function was improved from 2.32 ± 0.5 mg/dL to 1.72 ± 0.3 mg/dL (P < 0.001) and number of antihypertensive medications after the procedure was reduced from 2.9 ± 0.7 to 2 ± 0.6 (P < 0.001) at 6 months follow-up. One patient developed restenosis within 5 months (4.2%). Clinical success at 6 months follow-up was 79.2%.Conclusions:Endovascular treatment of TRAS has high technical success with minimal complications. It also provides satisfactory clinical success with improvement in overall transplant renal function and renovascular hypertension in early follow-up.

Objectives Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate.Materials and methods Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data.Results Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies. Conclusion Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.

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Aims and Objectives: To review a single centre experience in the evaluation, management and outcome of upper tract transitional cell carcinoma. Materials and Methods: We reviewed 18 cases over five years from January 2010 to October 2015 with a median follow up of 18 months. Patient characteristics including age, sex, symptoms and signs were reviewed. All patients were evaluated with ultrasound and contrast enhanced computerized tomography.  Tumour details including location, laterality, grade and stage was noted based on pathological findings.Results: The mean age of the patients included was 57 years. Most common presentation was haematuria (72%). Most common location of the tumours was renal pelvis (50%), followed by ureter (39%) and tumours in both renal pelvis and ureter in 11%. Concomitant bladder involvement was seen in 17% of the patients. Nephroureterectomy with excision of bladder cuff was the most common surgery performed (78%). 11% of the patients underwent renal sparing surgery and two other patients underwent nephroureterocystoprostatectomy. Morbidity rate was 22% and recurrence was seen in 16% of the patientsConclusion: Transitional cell carcinoma of the upper tract is a rare tumour which is known for its multicentricity and recurrence. .  Nephroureterectomy with excision of bladder cuff has been the gold standard for the management, although endosurgical and tumour sparing surgery in selected cases have proven to be equally efficacious. Tumour grade and surgical procedure performed are independent risk factors for recurrence.Asian Journal of Medical Sciences Vol. 7(3) 2016 84-88