Objectives: We sought to study the prevalence, risk factors, and long-term prognosis of posttransplant diabetes mellitus. Materials and Methods:We studied all patients with end-stage renal disease without diabetic nephropathy who received a kidney transplant and were followed-up at our center since 1983 (n=218; age, 44.3 ± 13.1 y). Patients with new-onset diabetes after transplant were compared to kidney transplant recipients without risk factors for diabetes mellitus. Patients with new-onset diabetes after transplant were divided into subgroups according to time of onset (early; < 90 d vs late, ≥ 90 d).Results: In total, 73/218 patients (33%) developed new-onset diabetes after transplant. Patients with new-onset diabetes after transplant were significantly older (51.2 ± 11.4 vs 40.7 ± 12.5 y; P < .001) and had a tendency to have a higher body mass index (29.6 ± 8.7 vs 21.6 ± 7.8 kg/m 2 ; P =.05) than those that did not have new-onset diabetes after transplant. In multivariate analysis, age (P < .001), hepatitis C virus infection (P < .05), family history of diabetes mellitus (P < .03), and tacrolimus use (P < .001) were independent risk factors. Fiveand 10-year death censored patient survival rates were worse in those that had new-onset diabetes after transplant compared with controls (log rank, 0.04), whereas there was no difference in outcomes between the early and late subgroups. Conclusions:The prevalence of new-onset diabetes after transplant was 33%. Age, body weight at time of transplant, tacrolimus use, family history of diabetes mellitus, and hepatitis C virus infection are independent risk factors for new-onset diabetes after transplant. New-onset diabetes after transplant has a negative effect on patient survival, irrespective of the time of onset and duration of diabetes.

Augmentation enterocystoplasty is an established procedure performed to increase bladder capacity and reduce intravesical pressure in patients with neurogenic bladder. Although the open surgical procedure remains the most widely accepted technique, laparoscopic enterocystoplasty has been described. As an extension of the minimally invasive approach, we describe a technique for robotic augmentation enterocystoplasty with a completely intracorporeal method. To our knowledge, this is the first report of such a technique.

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Introducere: Rinichii cu artere multiple reprezintã o provocare deosebitã pentru chirurg, atât în timpul nefrectomiei la donator cât şi al transplantului renal. Scopuri: Scopurile acestui studiu sunt evaluarea rezultatelor atât a donatorilor cât şi a recipienţilor rinichilor cu artere multiple procuraţi pe cale laparoscopicã. Pacienţi şi Metodã: Am analizat retrospectiv datele medicale a tuturor recipienţilor şi a donatorilor vii care au donat rinichi pe cale laparoscopicã între aprilie 2009 şi decembrie 2014. Detaliile intraoperatorii şi evoluţia imediatã au fost comparate între donatorii şi recipienţii de rinichi cu artere multiple şi donatorii şi recipienţii de rinichi cu arterã renalã unicã. Rezultate: Dintr-un total de 250 donatori la care s-a practicat nefrectomia laparoscopicã 43 (17,2%) au avut artere renale multiple. Timpul operator mediu a fost semnificativ statistic mai lung în grupul cu artere multiple (168,1 min vs 135,3 min; p=0,001), cu toate acestea durata ischemiei calde, respectiv rece, au fost similare în cele douã grupuri. Nu au fost consemnate complicaţii la donatorii din ambele grupuri, nici conversii la nefrectomia pe cale deschisã. Durata spitalizãrii postoperatorii a fost similarã pentru cele douã grupuri. Deasemenea nu a existat nici o diferenţã semnificativã statistic între rata funcţionãrii imediate a grefelor renale din ambele grupuri. Concluzii: Nefrectomia laparoscopicã la donatorii cu artere multiple este o procedurã sigurã şi nu are un impact semnificativ asupra evoluţiei ulterioare a donatorului sau a funcţionãrii grefei renale.

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