Vascular complications of renal transplantation

Palleschi, James R.; Novick, Andrew C.; Braun, William E.; Magnusson, Magnus O.

doi:10.1016/0090-4295(80)90333-7

Cited by 90 publications

(31 citation statements)

References 14 publications

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“…The reported incidence ranges from 1% to 23% and is associated with medically refractory hypertension and progressive allograft dysfunction; it can result from an inadequate suture technique, renal artery trauma, kinking of the artery, vascular type rejection, and atherosclerosis of the donor or the recipient arteries. [7][8][9][10] It should be suspected when there is an onset of hypertension or significant increase in blood pressure over previous levels, often accompanied by proteinuria and/or an increase in plasma creatinine levels. The prevalence of renal artery stenosis in transplant has increased with the introduction of new noninvasive diagnostic methods.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Complications After Pediatric Renal Transplant

Sozen

Fidan²,

Onur³

et al. 2019

Exp Clin Transplant

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Objectives: Renal transplant is the most appropriate treatment for both adult and pediatric patients with end-stage renal failure. Here, we analyzed surgical complications after pediatric renal transplant at our center. Materials and Methods:We retrospectively analyzed data from patient files and hospital charts of pediatric patients who had renal transplant at our center (Gazi University, Ankara, Turkey). Our immunosuppression protocol, a calcineurin inhibitor-based triple regimen, was applied to all recipients (steroids, mycophenolic acid). For neo-ureterocystostomy anastomosis, we used the corner-saving, open-loop continuous suture technique with double J stent for all patients, except when faced with an unfavorable situation. Catheters were removed within 4 weeks after transplant. Results: Among 40 pediatric renal transplant procedures performed at our center since 2006, we had 6 documented surgical complications (15%), with 3 being early and 3 being late complications. In the early transplant period, there were 2 surgical and 1 urologic complications. Eight patients (20%) lost their kidney grafts over the 10-year follow-up. The main reasons for graft loss were chronic allograft nephropathy in 4 patients (10%), BK virus nephropathy in 3 patients (7.5%), and hyperacute rejection in 1 patient (2.5%). Two patients died; however, no patient deaths or graft losses were from surgical complications. Overall graft and patient survival rates were 97% and 100% at 1 year, 94% and 98% at 5 years, and 68% and 95% at 10 years. Conclusions: Renal transplant in pediatric patients is a safe procedure in our department, based on patient and graft survivals, with a low rate of graft loss from surgical problems. As a result, our center is showing success with pediatric renal transplant procedures in accordance with the developed centers in the world.

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Section: Discussionmentioning

confidence: 99%

“…The prevalence of renal artery stenosis in transplant has increased with the introduction of new noninvasive diagnostic methods. [6][7][8][9][10] Care consists of surgical revision or percutaneous transluminal angiography with balloon dilatation or placement of an endovascular stent. None of the patients required surgical revision.…”

Section: Discussionmentioning

confidence: 99%

Surgical Complications After Pediatric Renal Transplant

Sozen

Fidan²,

Onur³

et al. 2019

Exp Clin Transplant

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“…The suture site stenosis is due to technical reasons and it is usually permanent [9]. The significant association of renal graft thrombosis and technical faults has been frequently stressed in most of reported series [10][11][12][13][14][15]. Despite progress in immunosuppressive treatment, surgical technique, prevention and management of infection the vascular complication account 3-15% of graft dysfunction cases [4,16,17].…”

Section: Discussionmentioning

confidence: 99%

Is Placing an Expansion Space at the Anastomosing Site of the Vessel for Prevention of Pursiness, Safe?

Zomorrodi¹,

Kakei²,

Farshi³

et al. 2012

J Transplant Technol Res

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Kidney replacement is the best option for treatment of chronic renal failure patient. This treatment sometimes associates with some complications including: immunologic, vascular and urologic. The vascular complication is a dangerous complication which sometimes may result in losing allograft kidney.The vascular complications including: thrombosis and stricture. These complications can be induced by rejection or by technical fault. The technical fault including: the handling of the vessel and suturing of the vessel. One of the preventable faults is pursiness which may predispose the vessel to the stenosis. We studied the making expansion space between the vessel and first knotting of stitching for prevention of the pursiness of the vessel post anastomosis. Material and methods:One hundred chronic kidney disease patients 51 males and 49 females with age between 15-67 have been operated for kidney transplant surgery at Imam Reza hospital (teaching hospital) since 2008 -2011. All of the patients have received allograft kidney from live unrelated donors. During surgery after preparation place for allograft kidney at retroperitoneal at fosse of iliac the internal iliac artery (hypogasteric artery) have been selected for renal artery anastomosis and external iliac vein have been selected for renal vein anastomosis. During vessel anastomosis between vessel and first knotting of stitching (continue suture with single thread) 5mm distance have been made as expansion space. After removing the clamp from the vessel bleeding has been controlled, post operation the kidney has been followed by color Doppler ultrasound.Results: Post declamping the vessel, the expansion space was vanished and the hemeostasis was nearly complete without any significant bleeding and also without detecting any stenosis at anastomosing site with follow up with color Doppler ultrasound at least for 6 months post operation.Conclusions: making expansion space between the first knot of stitching and the vessel at the anastomosing site for prevention of the pursiness of the vessel and stenosis is safe.

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“…Bu konuda yapılan çalışmalarda HLA uyumunun derecesi ile TRAS oluşumu arasında kesin bir ilişki gösterilememesine karşın, akut rejeksiyon epizodlarmm TRAS gelişimi ile çok yakın ilişkisi olduğu bildirilmektedir (8,10,11). TRAS sebebiyle öpere edilen hastaların renal arterlerinin en-dotelin.de C3 ve IgM depolanmasının gösterilmesi nedeniyle TRAS etyolojisinde immünolojik faktörlerin önemli rolü olduğu öne sürül-mektedir (13). TRAS ile immünolojik intoleransm (rejeksiyon) ko-insidensinin belirgin oluşu sebebiyle, TRAS'nun immünolojik hasarın vasküler belirtisi olabileceği iddia edilmektedir (11).…”

Section: Gün Medikalunclassified

Renal Transplantasyon Sonrasi Transplant Renal Arter Stenozu

Erbay¹,

Anadol²,

Aydıntuğ³

et al. 1994

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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Günümüzde kronik dializ tedavisi ile üremik hastaların yaşam sürelerinin uzatılmasına karşılık, hastaların yaşam kalitelelerinin, arttırılması ve rehabilitasyonlarmm sağlanması oldukça yetersizdir. Cerrahi alandaki teknik gelişmeler, immünolojideki ilerlemeler ve yeni immünosupressif ajanların klinik uygulamaya girmesi ile, renal transplantasyonlardaki başarı oranı oldukça artmış olup, renal transplantasyon olgularmdaki yıllık mortalite oram yaklaşık % 50 oranın-dan % 10'un altma düşmüştür (21). Bu nedenle, renal transplantasyon son dönem böbrek yetmezlikli hastalarda ideal tedavi seçeneği olarak kabul edilmekte ve tüm dünyada olduğu gibi ülkemizde de giderek artan sayılarda uygulanmaktadır.Renal transplantasyon uygulaması sırasında cerrahi ve medikal komplikasyonlar görülebilmekte ve bunlara bağlı olarak graft sürvi ve hasta mortalitesi oranları olumsuz yönde etkilenmektedir. Posttransplant dönemde bu komplikasyonlarm dikkatle izlenmesi ve tedavisi transplant uygulamasının başarılı olmasını sağlar.Renal arter stenozu, böbrek transplantasyonundan sonra en sık gözlenen vasküler komplikasyonlardan olup, değişik merkezlerdeki

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Vascular complications of renal transplantation

Cited by 90 publications

References 14 publications

Surgical Complications After Pediatric Renal Transplant

Surgical Complications After Pediatric Renal Transplant

Is Placing an Expansion Space at the Anastomosing Site of the Vessel for Prevention of Pursiness, Safe?

Renal Transplantasyon Sonrasi Transplant Renal Arter Stenozu

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