Atherosclerosis is common in patients with end-stage renal disease. Severe calcification of the iliac vessels is expected in the growing pool of kidney transplant candidates. Thus, transplant surgeons must constantly develop alternative operative strategies to deal with the technical challenges that this condition confers. This case report aims to highlight a reconstructive vascular technique to salvage a completely calcified recipient external iliac artery using a deceased donor's arterial iliac allograft from the same donor as the renal allograft in a 59-year-old man, as an effective method to decrease vascular complications.
Introduction
Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value.
Objectives
To determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors.
Methods
Retrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. did (Drain, D) receive a drain at the time of transplant was performed. The primary outcome was the development of any wound complication (superficial or deep) during the first 12 months post-transplant. Secondary outcomes included the development of superficial wound complications, deep wound complications, DGF, and graft loss during the first 12 months post-transplant.
Results
388 and 112 recipients had DF/D, respectively. DF-recipients were significantly more likely to be younger, not have pre-transplant diabetes, receive a living donor kidney, receive a kidney-alone transplant, have a shorter duration of dialysis, shorter mean cold-ischemia-time, and greater pre-transplant use of anticoagulants/antiplatelets. Wound complications were 4.6% (18/388) vs. 5.4% (6/112) in DF vs. D groups, respectively (P = 0.75). Superficial wound complications were observed in 0.8% (3/388) vs. 0.0% (0/112) in DF vs. D groups, respectively (P = 0.35). Deep wound complications were observed in 4.1% (16/388) vs. 5.4% ((6/112) in DF vs. D groups, respectively (P = 0.57). Higher recipient body mass index and ≥ 1 year of pre-transplant dialysis were associated in multivariable analysis with an increased incidence of wound complications. Once the prognostic influence of these 2 factors were controlled, there was still no notable effect of drain use (yes/no). The lack of prognostic effect of drain use was similarly observed for the other clinical outcomes.
Conclusions
In a relatively large cohort of renal transplant recipients, routine surgical drain use appears to offer no distinct prognostic advantage.
The COVID-19 pandemic has been affecting surgical residents in many ways and to varying degrees. While the senior surgical residents have been facing a drastic decrease in the operation time, the junior surgical residents have been exposed to an increased number of beside procedures. However, both of them have been affected by an increased exposure to deaths. This sudden exposure to this amount of deaths can, and has been, greatly impressing mostly the young surgeon generation, still green and impressionable. PGY-1 residents have been balancing emotional confusion between the eagerness of learning new procedures and the anguish coming from facing the loss of patients that they have been trying so hard to save day by day. This situation is leading to an increase in burn-out cases, mostly from the general physicians and health care providers. The real effect of this emotional distress is still unknown and it will be topic of further studies once situation is resolved. This article is described using a multidisciplinary approach, giving a PGY-1 personal point of view and an inner philosophical prospective.
Carl Florian Toldt was an Austrian anatomist who made meaningful contributions worldwide and defined what is one of the most important surgical landmarks in abdominal surgery. Through his research studies, the embryologic dissection plane known as the “White Line of Toldt” represents an important anatomical landmark that helps to mobilize either the ascending or descending colon. His career spanned over 45 years, beginning in Verona and continuing to Prague and Vienna. He was an author of several innovative books and scientific articles regarding micro- and macroscopic anatomy. In addition, he received numerous recognitions and prizes for his work, making him an essential figure in the medical scientific community. Even a street in Vienna, Karl-Toldt-Weg, is named in his honor. The purpose of this historical article is to celebrate and honor Toldt 100 years following his death, remembering his scientific contributions to the medical and surgical fields and giving thanks for his numerous accomplishments. This article brings light to the man behind the eponym.
Increasing the organ donor pool and solving the recipient demands continue to be one of the challenges in transplantation. We report our experience in transplanting a living donor kidney requiring complex vascular reconstructions and an enucleation of complex cyst. A 57-year-old male patient underwent a living unrelated kidney transplant. The living donor kidney was procured through a laparoscopic hand-assisted right donor nephrectomy. After vascular stapling, the kidney had a short upper pole arterial branch, a short renal vein (3 mm), and a complex upper pole cyst. The renal vein was elongated using the donor ovarian vein and the short upper pole artery was extended using the recipient inferior epigastric artery and anastomosed to the main renal artery. The renal allograft vessels were anastomosed end-to-side to the external iliac vessels. The complex cyst was removed performing an enucleation with a rim of normal tissue and reconstruction of the calyceal system. This case represents three different surgical reconstructions in order to make the organ available for transplantation. In some circumstances, complex vascular reconstruction of living donor kidney with removal of complex cyst represents a strategy to expand the donor pool.
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