European Association of Urology Guidelines on Renal Transplantation: Update 2018

Faba, Ó. Rodríguez; Boissier, R.; Budde, Klemens; Figueiredo, Arnaldo; Taylor, Claire; Hevia, Vital; García, E. Lledó; Regele, Heinz; Zakri, Rhana Hassan; Olsburgh, Jonathon; Breda, Alberto

doi:10.1016/j.euf.2018.07.014

Cited by 88 publications

(48 citation statements)

References 41 publications

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“…To date, most groups performing RAKT replicated the Vattikuti-Medanta technique (1). Nevertheless, specific modifications have been proposed by several teams to adapt the technique to the availability of surgical instrumentation, logistical issues, and surgeon's preference during the learning curve (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

The University of Florence Technique for Robot-Assisted Kidney Transplantation: 3-Year Experience

et al. 2020

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Objective: To report the University of Florence technique for robot-assisted kidney transplantation (RAKT) from living donor (LD) and deceased donor (DD), highlighting the evolution of surgical indications and technical nuances in light of a single surgeon's learning curve. Materials and Methods: A dedicated program for RAKT from LDs was developed at our Institution in 2017 and implemented later with a specific framework for DDs. All RAKTs were performed by a single highly experienced surgeon. Data from patients undergoing RAKT between January 2017 and December 2019 were prospectively collected in a dedicated web-based data platform. In this report we provide a comprehensive step-by-step overview of our technique for RAKT, focusing on the potential differences in peri-operative and mid-term functional outcomes between LDs vs. DDs. Results: Overall, 160 KTs were performed in our center during the study period. Of these, 39 (24%) were performed with a robot-assisted laparoscopic technique, both from LDs ( n = 18/39 [46%]) and from DDs ( n = 21/39 [54%]). Eleven (11/39 [18%]), 13(13/39 [26%]), and 15 (15/39 [30%]) RAKTs were performed in 2017, 2018, and 2019, respectively, highlighting an increasing adoption of robotics for KT over time at our Institution. Median time for arterial (19 min for LD and 18 min for DD groups), venous (21 min for LD, 20 min for DD) and uretero–vesical (18 min for LD and 15 for DD) anastomosis were comparable between the two groups (all p > 0.05), as the median rewarming time (59 min vs. 56 min, p = 0.4). The rate of postoperative surgical complications according to Clavien–Dindo classification did not differ between the two study groups, except for Clavien–Dindo grade II complications (higher among patients undergoing RAKT from DDs, 76 vs. 44%, p = 0.042). Overall, 7/39 (18%) patients (all recipients from DDs) experienced DGF; two of them were on dialysis at last FU. Conclusions: Our experience confirms the feasibility, safety, and favorable mid-term outcomes of RAKT from both LDs and DDs in appropriately selected recipients, highlighting the opportunity to tailor the technique to specific recipient- and/or graft-characteristics. Further research is needed to refine the technique for RAKT and to evaluate the benefits and harms of robotics for kidney transplantation from DDs.

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Section: Introductionmentioning

confidence: 99%

The University of Florence Technique for Robot-Assisted Kidney Transplantation: 3-Year Experience

et al. 2020

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“…Left kidney donor nephrectomy is technically easier to perform due to a longer renal vein, which provides implantation advantages. In addition, using the transperitoneal approach in right kidney RLDN is more difficult because the presence of the liver complicates the dissection [ 59 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Surgical Techniques in Living Donor Nephrectomy: A Systematic Review and Bayesian Network Meta-Analysis

Xiao

Song

et al. 2020

Ann Transplant

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“…Ureteric pathology is more common than vascular pathology, but rarely affects graft survival [93]. The most common early urological complication is a urine leak with an estimated incidence of 8%, followed by ureteric stenoses with a similar incidence occurring later in the transplant course [77,94]. Other complications of vesicoureteric reflux and urolithiasis are uncommon [95].…”

Section: Renal Ureteric Complicationsmentioning

confidence: 99%

“…Ureteric leaks, like vascular pathology, typically occur in first few weeks post-transplant and may present with localised pain or swelling at the site of the allograft, increased surgical drain output or a peri-transplant collection seen on imaging [95]. Non-technical risk factors include recipient agent, pre-transplant urological pathology, immunosuppressive regimen and donor factors [94].…”

Section: Renal Ureteric Complicationsmentioning

confidence: 99%

Perioperative Care for Kidney Transplant Recipients

Hultin¹,

Hawley²,

Johnson³

et al. 2019

Perioperative Care for Organ Transplant Recipient

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Transplantation carries significant mortality benefit compared to dialysis in end-stage kidney disease. Increased perioperative risk, however, results in a higher mortality in the first 3 months post-transplantation compared to remaining on haemodialysis. Consequently, optimal perioperative management is essential. Patients presenting for kidney transplantation require rapid assessment and preparation for theatre to minimise ischaemic times and improve mortality and graft outcomes. This task is often complicated by the presence of multiple medical comorbidities. Furthermore, early complications of hypotension, delayed graft function, renovascular and ureteric surgical complications and rejection render the perioperative phase of transplant challenging for the recipient and for the transplant team. In this chapter, we outline current practices in the assessment and management of kidney transplant recipients during the perioperative period, particularly focusing on their clinical application and the evidence underpinning them.

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European Association of Urology Guidelines on Renal Transplantation: Update 2018

Cited by 88 publications

References 41 publications

The University of Florence Technique for Robot-Assisted Kidney Transplantation: 3-Year Experience

The University of Florence Technique for Robot-Assisted Kidney Transplantation: 3-Year Experience

Comparison of Surgical Techniques in Living Donor Nephrectomy: A Systematic Review and Bayesian Network Meta-Analysis

Perioperative Care for Kidney Transplant Recipients

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