En bloc transplantation optimizes the outcome of transplantation with very young kidneys. We recommend induction therapy and cyclosporine immunosuppression with cyclosporine levels similar to adult target levels to minimize rejection episodes and, thus, improve outcome. These kidneys should be distributed nationally, because better HLA matching is associated with improved short-term graft survival. Our high ureteral leak rate indicates that alternatives to unstented ureteroneocystostomy should be considered.

Recipients of kidneys from HBsAg(-)/HBcAb(+) donors are at a small risk of hepatitis B seroconversion but are at no excess risk of graft failure or short-term morbidity or mortality.

In this study, we compare cholesterol levels during the first year after renal transplantation in FK506 (Prograf)- and cyclosporine-treated patients matched for cumulative first-year steroid dose and hypercholesterolemia risk factors. All patients had pretransplant cholesterol levels < 200 mg/dl. At 3 months posttransplant, 68% of the cyclosporine-treated patients had at least one cholesterol level greater than 200 mg/dl compared with 30% of the FK506-treated patients (P < 0.05). At the end of the year, 26% of FK506- and 67% of cyclosporine-treated patients remained hypercholesterolemic (P < 0.05). We conclude that cyclosporine has inherently more effect on cholesterol levels than FK506 during the first year after kidney transplantation.

With the incidence of robot-assisted radical prostatectomy (RALP) increasing, questions regarding the significance of margin status have arisen. Patients with a history of a prior transurethral resection of the prostate (TURP) may have a higher incidence of positive margins because of the prior surgery. We examined our IRB-approved database to determine whether patients who had undergone a prior TURP had higher rates of positive margins than patients who had no history of TURP. Between July 2003 and March 2007, six urologic surgeons in our medical group (City of Hope medical group) performed RALP on 2,041 patients. Consent to enter the database was obtained from 1,768 patients. Of these, 51 had undergone prior TURP. Patients with a history of TURP before undergoing RALP had positive margin rates of 35.3% (18 of 51) compared with 17.6% (18 of 102) of patients without a history of TURP (P = 0.015). The location of the positive margins was statistically more prevalent at the bladder neck in TURP patients (13.7 vs. 2.0%) than in non-TURP patients (Fisher's exact P value = 0.004). These two groups were statistically similar with regard to other variables examined including race, BMI, preoperative PSA, Gleason score, and pathologic stage. Patients who underwent RALP following TURP were found to have a higher positive margin rate. The positive margins were more likely to be located at the bladder neck in TURP versus non-TURP patients.

Experienced robotic surgeons report lower estimated blood loss (EBL) and transfusion rates with similar clinical outcomes for robotic assisted laparoscopic radical prostatectomy (RALP) compared to open radical retropubic prostatectomy (RRP). We reviewed our experience with RALP to investigate how to counsel overweight and obese patients being considered for RALP regarding risk of major perioperative complications, oncological outcomes, and short-term recovery. We reviewed the data on 1,513 patients who underwent RALP by one of four experienced robotic surgeons between June 2003 and November 2006. These patients were categorized as normal, overweight, obese, and severely obese based on body mass index (BMI). Of these patients, 361 (23.9%) had a BMI under 25, 794 (52.5%) had a BMI between 25 and 30 (overweight), 290 (19.2%) had a BMI between 30 and 35 (obese), and 68 (4.5%) had a BMI over 35 (severely obese). Records were examined and analyzed with respect to BMI for major intra- and perioperative complications, operative time, margin status, EBL, transfusion rates, and length of hospital stay. Increasing BMI was associated with longer operative time, with mean operative times of 2.7, 2.8, 3.1, and 3.3 h for normal, overweight, obese and severely obese patients, respectively (P < 0.0001). Higher blood loss, though not clinically significant, was also associated with increased BMI, with obese and severely obese patients losing a median of 250 mL of blood compared to 200 mL in overweight and non-overweight patients (P < 0.0001). Transfusion rates, intra- and perioperative complications, margin status, and length of stay were not found to be associated with BMI group. Robotic assisted laparoscopic radical prostatectomy in experienced hands can be safely recommended to eligible patients regardless of BMI status.