Recipients of extended-criteria donor (ECD) kidneys have poorer long-term outcomes compared to standard-criteria donor kidney recipients. We report 3-year outcomes from a randomized, phase III study in recipients of de novo ECD kidneys (n = 543) assigned (1:1:1) to either a more intensive (MI) or less intensive (LI) belatacept regimen, or cyclosporine. Three hundred twenty-three patients completed treatment by year 3. Patient survival with a functioning graft was comparable between groups (80% in MI, 82% in LI, 80% in cyclosporine). Mean calculated GFR (cGFR) was 11 mL/min higher in belatacepttreated versus cyclosporine-treated patients (42.7 in MI, 42.2 in LI, 31.5 mL/min in cyclosporine). More cyclosporine-treated patients (44%) progressed to GFR <30 mL/min (chronic kidney disease [CKD] stage 4/5) than belatacept-treated patients (27-30%). Acute rejection rates were similar between groups. Posttransplant lymphoproliferative disorder (PTLD) occurrence was higher in belatacept-treated patients (two in MI, three in LI), most of which occurred during the first 18 months; four additional cases (3 in LI, 1 in cyclosporine) occurred after 3 years. Tuberculosis was reported in two MI, four LI and no cyclosporine patients. In conclusion, at 3 years after transplantation, immunosuppression with belatacept resulted in similar patient survival, graft survival and acute rejection, with better renal function compared with cyclosporine. As previously reported, PTLD and tuberculosis were the principal safety findings associated with belatacept in this study population.Key words: Belatacept, cyclosporine, extended criteria donor, kidney, renal function Abbreviations: BENEFIT-EXT, belatacept evaluation of nephroprotection and efficacy as first-line immunosupression trial-EXTended criteria donors; CI, confidence interval; CNS, central nervous system; DCD, donation after cardiac death; ECD, extended criteria donor; LI, less intensive; MI, more intensive; PTLD, posttransplant lymphoproliferative disorder; UNOS, United Network for Organ Sharing.

Planned conversion from tacrolimus to sirolimus was evaluated in de novo kidney transplant recipients. In this multicenter, randomized, open-label study, 297 patients were initially treated with tacrolimus, mycophenolate sodium and prednisone. Of the 283 patients reaching 3 months, 97 were converted to sirolimus (SRL), 107 were maintained on tacrolimus (TAC) and 79 were patients receiving TAC without criteria to undergo intervention at month 3 (TACex). The primary objective was to show superior estimated glomerular filtration rate (eGFR) in the SRL group at month 24. Of the 258 patients who completed 24 months, 91 (94%) were in the SRL group, 101 (94%) in the TAC group and 66 (84%) in the TACex group. In the intention-to-treat population there were no differences in eGFR (66.2 AE 25.3 vs. 70.7 AE 25.1, p ¼ 0.817) or in the severity of chronic sclerosing lesions scores in 24-month protocol biopsies. Higher mean urinary protein-tocreatinine ratio (0.36 AE 0.69 vs. 0.15 AE 0.53, p ¼ 0.03) and higher incidence of treated acute rejection between months 3-24 (13.4% vs. 4.7%, p ¼ 0.047) were observed in SRL compared to TAC group. In this population planned conversion from TAC to SRL 3 months after kidney transplantation was not associated with improved renal function at 24 months.

The anatomical variations of renal veins observed during 342 nephrectomies in living donors are described, 311 cases on the left side and 31 on the right. The following anatomy of the renocava veins was observed: 1. On the left side the renal vein was always unique (311/311) and had two tributaries (suprarenal and gonadal veins) in 100 per cent and one or more renolumbar veins in 65.27 per cent, encircling the aorta in 1.07 per cent, was retroaortic in 1.4 per cent; and the inferior vena cava was double in 0.64 per cent; B-on the right side the renal vein was double in 29 per cent (9/31) and had only one tributary (gonadal vein) in one case, for 3.22 per cent (1/ 31); three or more renal veins in 9.7 per cent (3/31). We concluded that the left renal vein is always unique, presenting variations principally in its tributaries and trajectory. On the right side, the renal vein was double or triple in 38.79 per cent UNITERMS: Nephrectomies. Renal veins. Kidney transplantation. INTROOUCTION It is crucial to know the anatomy of the renal vessels during a retroperitoneal approach to prevent bleeding by accidental tearing. I Comparably, the renal venous pattem of the right side bears little resemblance to that of the left. In its relatively short course from the kidney to the inferior vena cava, the right vein rarely receives a tributary. The longer left renal vein (LRV), on the contrary, regularly receives the following tributaries: suprarenal and inferior phrenic, from above, frequently joined; gonadal (testicular or ovarian) from below; and renolumbar vein posteriorly, often by a confluent with the gonadal vein. ,3Address for correspondence:José Carlos Costa Baptista-Silva Rua Prot. Artur Ramos, 178, 123-Vega São Paulo/SP -Brasil-CEP 01454-904 During the living donor nephrectomy, the left kidney is used more often as a donor organ because its vein is longer than the right renal vein. Usually, the LRV anteriorly crosses the aorta before reaching the vena cava. MATERIAL ANO METHOOSFrom May 1990 to May 1996, 342 living-donor nephretomies (311 on the left side and 31 on the right) were performed at Dom Silvério Gomes Pimenta (260) and Beneficência Portuguesa (82) HospitaIs. Of the 342, 208 cases were female and 134 male, 85 per cent were white, an~the average age was 43.8 years. All cases were studied through preoperative renal angiography and intraoperative observation.

Introduction: Infectious complications significantly increase morbidity and mortality after renal transplantation. The immunosuppression used is the main risk factor and relates directly to the incidence and severity of infectious events. Methods: This is a retrospective cohort study, which assessed the incidence of infections and their risk factors among 1,676 kidney transplant recipients during the first year of follow-up. Results: Infectious events were observed in 821 (49%) patients. The mean number of infectious episodes among patients with at least one episode was 2.3 (1 -12). The most prevalent infectious complications were as follows: urinary tract infection (31.3%); cytomegalovirus infection (12%); surgical wound infection (10.3%); herpes virus infection (9.1%); pulmonary infection (5.2%); and bloodstream infection (4.3%). Cold ischemia time and the use of deceased donor grafts were important risk factors for infectious episodes. Conclusions: Infections are highly prevalent in the first year following transplantation. The main infectious complication was urinary tract infection.