Impairment of long-term graft function after kidney transplantation by intraoperative vascular complications

Fechner, G.; Pezold, Carolin Von; Hauser, Stefan; Gerhardt, Thomas; Klehr, H. U.; Müller, Stefan

doi:10.1007/s11255-008-9387-y

Cited by 12 publications

(6 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean time to these vascular complications was 1.8 months after transplantation. Fechner et al [20] reported significant impairment of kidney function and graft survival in patients who were re-operated for vascular complications.…”

Section: Discussionmentioning

confidence: 99%

Vascular and haemorrhagic complications of adult and paediatric live-donor renal transplantation: A single-centre study with a long-term follow-up

Soliman

Shokeir

El‐Hefnawy

et al. 2012

Arab Journal of Urology

View full text Add to dashboard Cite

ObjectivesTo compare the haemorrhagic and vascular complications between paediatric and adult renal transplant recipients with a long-term follow-up.Patients and methodsBetween March 1976 and December 2006, in all, 1865 live-donor renal transplants were carried out. Patients were stratified according to their ages into two groups; paediatric (⩽18 years; 259) and adult (>18 years; 1606). Variables assessed included incidence, risk factors, management and sequelae of vascular and haemorrhagic complications. The effect of these complications on patient and graft survival was compared.ResultsHaemorrhage requiring active intervention (percutaneous drainage or surgical exploration) was reported in seven children (2.7%) and 29 adults (1.8%), while thrombotic or stenotic complications were recorded in two children (0.77%) and 19 adults (1.18%; P < 0.05). Female gender, delayed onset of diuresis and acute tubular necrosis were significant predictors of vascular complications on univariate analysis, but none remained significant on multivariate analysis. In adults, vascular complications had a significant negative effect on mean (SD) 10-year graft survival compared to patients with no complications, at 19.8 (7.63)% vs. 55.7 (1.66)% (P = 0.01). Children who developed vascular complications had a significantly higher 5- and 10-year graft survival rate than adults (P = 0.01).ConclusionThe incidence of vascular complications is comparable in paediatric and adult transplants. Vascular complications had a significant negative influence on graft survival in adult recipients. Children who developed vascular complications appear to tolerate its effects and have a better graft survival than have adults.

show abstract

Section: Discussionmentioning

confidence: 99%

Vascular and haemorrhagic complications of adult and paediatric live-donor renal transplantation: A single-centre study with a long-term follow-up

Soliman

Shokeir

El‐Hefnawy

et al. 2012

Arab Journal of Urology

View full text Add to dashboard Cite

show abstract

“…Additionally, end to end anastomosis has been observed to have a worse rate of graft survival than end to side anastomosis and a threefold increased chance of developing stenosis (27). (28). In this research, we assessed the method for sequentially joining the internal iliac artery and the auxiliary lower polar graft artery end to side.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, end to end anastomosis had been observed to have a worse rate of graft survival than end to side anastomosis and to have a threefold greater chance of developing stenosis (35). (36).…”

Section: Discussionmentioning

confidence: 99%

Results of anastomosis of accessory lower polar graft artery to internal iliac artery in renal transplantation

Abd-Elaziz

Elbatanouny

Lawindy

et al. 2022

ijhs

View full text Add to dashboard Cite

Background: Our objective is to perform a renal graft transplant using multiple arteries where the lower polar artery will indeed be anastomosed to the internal iliac artery end to side following declamping the main arterial supply in terms of ischemia time, diuresis, graft perfusion, and postoperative clinical parameters and investigations. Methods: Fifty live donors underwent vascular anastomosis of the graft auxiliary lower polar artery to recipient internal iliac artery end to side anastomosis with various renal arteries bilaterally, including lower polar artery in chosen kidney. The recipients' intraoperative warm and total ischemia periods, as well as their postoperative incidence of acute tubular necrosis, were assessed (ATN). Diuresis, urinary output, and creatinine levels at 1, 3, and 5 days after surgery, as well as at 2 months afterwards. MRI and Doppler ultrasonography, if necessary. Results: In contrast to warm, the mean total ischemia time was 20.86 minutes. Low incidence of ATN (8%) was controlled and postoperative recovery went without a hitch. Regarding postoperative urine output and serum creatinine level monitoring, clinical and laboratory indicators were satisfactory. Depending on the assessment method, colour Doppler ultrasonography reveals well perfused transplanted grafts with a satisfactory peak systolic velocity ratio in the auxiliary graft artery.

show abstract

“…This decision was based on kidney transplantation being major surgery involving the anastomosis of large vessels, with previous reports showing that 4.5–5.0% of kidney transplant recipients required surgical or radiologic reintervention for bleeding or graft hematoma . Hemorrhagic complications requiring surgical intervention significantly increase the risk of graft loss . We had avoided fibrinogen supplementation during peritoneal catheter placement out of consideration for its effect on future kidney transplantation, as acquired inhibitors can be produced after replacement therapy .…”

Section: Discussionmentioning

confidence: 99%

Successful living‐related kidney transplantation in a boy with inherited dysfibrinogenemia

Imamura

Akioka

Asano

et al. 2013

Pediatric Transplantation

View full text Add to dashboard Cite

In kidney transplantation, it is essential to avoid acute vascular complications, such as hemorrhage and renal vascular thrombosis, which may often lead to allograft loss. Inherited dysfibrinogenemia is a rare coagulation disorder with a wide spectrum of clinical manifestations, such as excessive bleeding and thrombosis. A 12-yr-old boy, previously diagnosed with renal hypodysplasia, was found to have reduced fibrinogen concentrations. Coagulation tests assessing surgical risk during kidney transplantation showed a discrepancy between functional and immunologic fibrinogen concentrations. Gene analysis confirmed inherited dysfibrinogenemia, with a heterozygous mutation in FGA (Aα Arg16His) in the patient and his mother. Based on the molecular and functional properties of the mutation, and a familial phenotype, in which his aunt had experienced a previous bleeding episode, the patient was considered at greater risk of bleeding than of thrombosis. The patient was administered fibrinogen concentrate before surgery, and kidney transplantation was performed with his father as the organ donor. The patient received additional prophylactic infusions of fibrinogen concentrate postoperatively, and his postoperative course was uneventful. Accurate diagnosis of dysfibrinogenemia, including gene analysis, is important for correctly managing patients with this coagulation disorder who are undergoing kidney transplantation.

show abstract

Impairment of long-term graft function after kidney transplantation by intraoperative vascular complications

Abstract: Our data emphasize the importance of vascular complications compared to ureteral ones in kidney transplantation. Resolving 'non-urological' problems successfully, kidney transplantation is a safe procedure in urological hands.

Cited by 12 publications

References 12 publications

Vascular and haemorrhagic complications of adult and paediatric live-donor renal transplantation: A single-centre study with a long-term follow-up

Vascular and haemorrhagic complications of adult and paediatric live-donor renal transplantation: A single-centre study with a long-term follow-up

Results of anastomosis of accessory lower polar graft artery to internal iliac artery in renal transplantation

Successful living‐related kidney transplantation in a boy with inherited dysfibrinogenemia

Contact Info

Product

Resources

About