Renal transplantation in patients with abdominal aortic aneurysm?a new surgical approach

Abstract

An increasing number of abdominal aortic aneurysms occurs in renal failure patients because of an accelerated atherosclerosis process associated with uraemia. When technically feasible, endovascular repair of an abdominal aortic lesion should be considered as the treatment of choice. If a surgical repair is suggested, there are several options to select from. Since November 1999, we performed simultaneous aortic reconstruction using fresh arterial allograft and kidney transplantation in five uraemic patients with asymptomatic abdominal aortic aneurysm. The operative and postoperative course of four patients passed without major complications. One patient had ischaemic colitis early after the operation, which required a partial resection of the colon. One patient died 6 weeks after the operation due to non-vascular causes. In conclusion, the advantage of our single-phase procedure is that both diseases are treated simultaneously during a single hospital stay. Moreover, with our procedure, the risk of vascular graft infection in patients with chronic immunosuppression is low.

Delayed administration of FK 506 is sufficient to suppress acute rejection changes after aortal transplantation in rats

“…immune system in patients after the removal of an infected prosthesis, followed by an arterial transplantation, has not yielded a definite solution yet [1,35,36]. The present study considered a possibility of delaying the administration of FK 506 after an arterial transplantation for 1 week without any influence on morphological signs of an acute arterial wall rejection.…”

“…However, the use of immunosuppression after an alloarterial or allovenous transplantation to increase the patency rate of reconstructions in humans is not widely accepted. Moreover, the suppression of the immune system in patients after the removal of an infected prosthesis, followed by an arterial transplantation, has not yielded a definite solution yet [1,35,36].…”

Safety of dual kidney transplantation compared to single kidney transplantation from expanded criteria donors: a single center cohort study of 39 recipients

“…None of the recipients of our series benefited from that technique, which was nevertheless reported in our centre previously . However, in case of important atheromatous iliac artery, renal transplantation after or simultaneously to vascular prosthesis implantation has been many times reported , with a higher morbidity and a graft loss rate around 10% . If we take for granted that the ipsilateral DKT causes more graft venous thrombosis, we have to actually balance the increased morbidity of the multiplication of arterial anastomosis on vascular prosthesis in case of bilateral access with the increased risk of graft venous thrombosis in case of single access.…”

Immunosuppressive protocols with tacrolimus after cryopreserved aortal allotransplantation in rats

“…All these facts about immunogenicity of arterial allografts, tacrolimus-based immunosuppression and our good results with triple immunosuppression in patients after simultaneous organ and vascular transplantation [ 40 ] led our group to study the immunosuppressive protocol with tacrolimus after rat cold-stored abdominal aortic transplantation in 2002 [ 13 ]. Subsequently in 2004, we started to use in patients after replacement of infected vascular prosthesis or stentgraft with cold-stored arterial allograft a standardized immunosuppressive protocol consisting of orally administered tacrolimus [ 4 ].…”