Combined Heart-Liver-Kidney Transplantation: The First Experience in Latin America

Fernandes, Eduardo de Souza Martins; Silva, Filipe Roza da; Segalote, Rodrigo; Rocha, Pedro Túlio; Mello, Felipe Pedreira Tavares de; Girão, Camila Liberato; Andrade, Ronaldo; Pimentel, Leandro Savattone; Cesar, Camila; Siqueira, Munique; Baamonde, Adolpho; Souza, Gabrielle Oliveira de; Furtado, Rodrigo; Queiroz, Camila Tobias; Almeida, Thays Ribeiro Rodrigues de; Galhardo, Carlos; Mourad, Gabriel; Robalinho, Felipe; Brito-Azevedo, Anderson

doi:10.1590/0102-672020210002e1668

Cited by 3 publications

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References 5 publications

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“…Similarly, in Brazil, 35% of transplanted children have urological anomalies as the primary etiology of renal function loss 17 . While kidney transplantation is acknowledged for its cost-effectiveness and enhancement of patient survival and quality of life compared to dialysis, a prerequisite for successful renal transplantation in these patients is the optimization of the lower urinary tract to prevent compromise to the graft, as observed in native kidneys 11 , 21 .…”

Section: Introductionmentioning

confidence: 99%

Bladder Transplantation: The New Frontier in Abdominal Organ Transplantation

PIOVESAN,

ANDRAUS,

PELLANDA

et al. 2024

ABCD, arq. bras. cir. dig.

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Lower urinary tract abnormalities are directly implicated in the etiology of renal dysfunction in 6 to 24% of dialytic patients. These patients require bladder capacity and compliance readjustment before being considered viable candidates for renal transplantation. Vesical augmentation surgeries often involve the use of intestinal segments. Although these procedures can effectively restore bladder capacity and compliance, they present various issues related to maintaining mucous absorption and secretion capacity. Acidosis, recurrent urinary tract infections, and stone formation are extremely common, leading to frequent hospitalizations and graft function loss. Urinary tissue is certainly ideal for these reconstructions; however, bladder augmentation using ureter and renal pelvis are feasible only in a minority of cases. Experimental studies have been conducted to establish the groundwork for vascularized bladder transplantation. Last year, for the first time, this procedure was performed on a brain-dead patient. During this intervention, cystectomy was performed with preservation the vascular pedicle, followed by organ reimplantation. The graft remained viable for a period of 12 hours post-transplant. However, this intervention utilized a robotic platform, making it less reproducible in a multi-organ procurement setting as well as for most transplant centers. Moreover, it is debatable whether the benefits of exclusive bladder transplantation outweigh the risks associated with immunosuppression. For patients needing renal transplantation and requiring lower urinary tract reconstruction, however, utilizing the donor’s bladder may offer an attractive alternative, avoiding the inherent complications of enterocystoplasty without increasing immunological risk. Combined kidney and bladder transplantation has the potential to emerge as the next frontier in abdominal organ transplants.

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Section: Introductionmentioning

confidence: 99%