Successful Homotransplantation of the Human Kidney Between Identical Twins

Merrill, John P.

doi:10.1001/jama.1956.02960390027008

Cited by 683 publications

(156 citation statements)

References 10 publications

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“…The strengths of our study include the following: 1 the analysis of key factors of robot‐assisted kidney transplantation in a preclinical setting; 2 the implementation of a novel intra‐abdominal cooling system designed to intra‐operatively cool the donor kidney; and 3 a detailed and real‐time analysis of kidney temperature starting before kidney retrieval and pursued up to complete reperfusion. Several factors indicate that temperature control is of crucial importance in robot‐assisted kidney transplantation: in the study by Oberholtzer et al, the robotic group had 1.4‐times higher creatinine levels at discharge (p < 0.05), more delayed graft function (DGF) (p > 0.05, not statistically significant), and more rejection episodes (p > 0.05, not statistically significant) 10.…”

Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Meier

Piller

Hagen

et al. 2018

American Journal of Transplantation

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Robot‐assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra‐abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra‐abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p‐values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia–reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot‐assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra‐abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia–reperfusion injuries.

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Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Meier

Piller

Hagen

et al. 2018

American Journal of Transplantation

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“…2 Historically, renal transplant surgery was primarily conducted by urologists, given that it clearly fell within the purview of renal surgery. 3,4 However, in more modern times, with the increased complexity and specialization of Surgical representation in Canadian renal transplantation the transplant field, the role of urology in renal transplant has been declining.…”

Section: Discussionmentioning

confidence: 99%

“…1 Naturally, renal surgery is second nature to the urologist, and historically all aspects of renal transplant surgery were overseen and performed by urologic surgeons. 2,3 More recently, there has been a trend towards decreased involvement of urology in all aspects of the renal transplantation process, including the recipient transplant, donor nephrectomy, and the medical management of the recipient. [3][4][5][6] However, limited data currently exists regarding the current environment of renal transplant in Canada.…”

Section: Introductionmentioning

confidence: 99%

Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

McGregor

Bjazevic

Patel

et al. 2016

CUAJ

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Introduction: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada. Methods: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected. Results: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds. Conclusions: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients. IntroductionRenal transplantation remains the gold standard treatment for end-stage renal disease (ESRD) worldwide, offering improved survival and quality of life for transplant recipients.1 Here in Canada, a total of 2367 renal transplant surgeries were performed in 2013. 1 The incidence of ESRD, and number of renal transplants performed, has been steadily increasing in Canada since 2003, demonstrating the need for well-trained transplant surgeons.1 Naturally, renal surgery is second nature to the urologist, and historically all aspects of renal transplant surgery were overseen and performed by urologic surgeons.2,3 More recently, there has been a trend towards decreased involvement of urology in all aspects of the renal transplantation process, including the recipient transplant, donor nephrectomy, and the medical management of the recipient.3-6 However, limited data currently exists regarding the current environment of renal transplant in Canada. To gain a better idea of the current involvement of urology in the Canadian transplant arena, we performed a poll of all Canadian transplant programs to determine what surgical subspecialties were performing the transplant surgeries and to see if their involvement varied between the various components of the transplant process. MethodsFollowing approval from the University of Manitoba ethics review board, ...

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“…5 The first success was a fraternal twin recipient treated by the Boston plastic surgeon and future Nobel laureate, Joe Murray. 6 All of the first 6 patients were irradiated before transplantation but had limited therapy afterwards because drug immunosuppression was not yet available. The exceptional seventh patient (also a Brigham patient of Murray) was not irradiated but was treated daily with azathioprine throughout the 17 months of graft function.…”

Section: Anatomy Of An Errormentioning

confidence: 99%

Anatomy of an Error

Starzl

2014

Vascularized Composite Allotransplantation

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Successful Homotransplantation of the Human Kidney Between Identical Twins

Cited by 683 publications

References 10 publications

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

Anatomy of an Error

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