Surgical Complications in Kidney Transplantation: An Overview of a Portuguese Reference Center

Carvalho, Joana; Nunes, Pedro; Antunes, Hugo; Parada, B.; Tavares-da-Silva, Edgar; Rodrigues, Luís; Roseiro, A.; Bastos, C.; Macário, Fernando; Figueiredo, Arnaldo

doi:10.1016/j.transproceed.2019.05.001

Cited by 23 publications

(21 citation statements)

References 13 publications

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“…They observed that surgical complications after kidney transplants lead to prolonged hospitalisation and decreased graft survival. 51 Though most of the studies show similar results, some have also shown conflicting results (see Table 1). [50][51][52][53][54] Extraperitoneal low-volume urine leak may be managed conservatively.…”

Section: Different Clinical Presentations Of Urine Leakmentioning

confidence: 97%

“…These investigators found that the patients with urine leak had a statistically significant longer length of hospital stay, more readmissions, more delayed graft function, and lower rates of graft survival. 50 In another observational cross-sectional study of 3,102 kidney transplant patients, Carvalho et al 51 found that surgical complications occurred in 527 (17.0%) patients and urinary complications in 184 (5.9%). The most common complications observed were ureteral obstruction (in 85 patients; 2.7%) and urinary fistula (in 72 patients; 2.3%).…”

Section: Different Clinical Presentations Of Urine Leakmentioning

confidence: 99%

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Identifying Early Extraperitoneal High-Volume Urine Leak Post Kidney Transplantation

Churchill

Sharma

Aziz

et al. 2021

EMJ

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Transplant clinicians need to be watchful of several potential surgical complications in the early post-transplant period, including haemorrhage, extraperitoneal urine leak, and lymphocele. While haemorrhage and extraperitoneal urine leak usually present in the early post kidney transplant period, lymphoceles usually present 2–6 weeks after transplantation. While the colour and volume of the drained fluid can give some indication of the problem, is not enough evidence for a confident urine leak diagnosis. Further investigations, such as serum biochemical parameter analysis of the drained fluid and ultrasonography, help to identify the true cause. This paper discusses how to identify high-volume extraperitoneal urine leaks in the early post kidney transplant period and considers the differential diagnoses. Different ureteroneocystostomy procedures, including the Lich–Grégoir, Politano–Leadbetter, and U-stitch techniques, are discussed and compared regarding complication rates (especially urine leak and haematuria). The authors also address the management of low- and high-volume extraperitoneal urine leak, the follow-up needed, and the impact of urine leak on graft and patient survival, length of hospital stay, and rate of hospital readmission.

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Section: Different Clinical Presentations Of Urine Leakmentioning

confidence: 97%

Section: Different Clinical Presentations Of Urine Leakmentioning

confidence: 99%

Identifying Early Extraperitoneal High-Volume Urine Leak Post Kidney Transplantation

Churchill

Sharma

Aziz

et al. 2021

EMJ

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“…U pacijenta s augmentacijom mokraćnoga mjehura došlo je do razvoja kamenca u pijelonu, te mu je uspješno učinjena mini perkutana nefrolitotripsija (mini PCNL). Uzrok nastanka kamenca bila je stenoza anastomoze uretera i augmentiranog mjehura [4][5][6][7] . Većina tih komplikacija je vezana uz ureter odnosno ureterovezikalnu anastomozu.…”

Section: Ispitanici I Metodeunclassified

“…Kako bi se smanjio rizik nastanka nekroze neoophodno je sačuvati vaskularizaciju distalnog dijela uretera 18 . Također se preporučuje i rutinsko korištenje JJ endoproteze 17,32,34 7,38,39 . Iz tablice 2 vidljivo je kako je većina pacijenata u drugom razdoblju morala biti liječena kirurški, pogotovo oni u kojih je došlo do razvoja nekroze uretera.…”

Section: Ispitanici I Metodeunclassified

Urološke komplikacije nakon transplantacije bubrega – iskustvo Referentnog centra u Hrvatskoj

Markić

Oguić

Sotošek

et al. 2020

Med. Flum. (Online)

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Cilj: Prikazati učestalost uroloških komplikacija nakon transplantacije bubrega u našem transplantacijskom centru. Ispitanici i metode: Retrospektivnim istraživanjem bili su obuhvaćeni svi pacijenti u Kliničkom bolničkom centru Rijeka u kojih je između 30. siječnja 1971. godine i 31. prosinca 2018. godine učinjena transplantacija bubrega. Rezultati: U promatranom razdoblju u našem transplantacijskom centru učinjeno je 1160 transplantacija bubrega. Urološke komplikacije imala su ukupno 154 pacijenta (13,3 %). Najčešće komplikacije su bile stenoza uretera u 52 pacijenta (4,5 %), urinarna fistula u 50 pacijenata (4,3 %), retencija urina u 23 pacijenta (1,9 %) te urolitijaza u 8 pacijenata (0,7 %). U većine pacijenata je provedeno kirurško liječenje. U posljednje vrijeme značajno se povećalo rješavanje uroloških komplikacija korištenjem minimalno-invazivnih metoda. U dvoje pacijenata (0,17 %) je zbog uroloških komplikacija došlo do gubitka grafta, a u troje pacijenata (0,25 %) su one dovele do smrtnog ishoda. Zaključak: Urološke komplikacije u našoj transplantacijskoj populaciji nisu česte. U pacijenata u kojih je potrebno kirurško liječenje endourološke metode predstavljaju danas inicijalnu metodu liječenja.

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“…Early vascular complications are among rare complications that can arise during the posttransplant period [1,2]. Vascular complications can have severe consequences [1,2], which may include arterial and venous thrombosis, renal artery stenosis, renal artery kinking and renal artery laceration or dissection. Acute surgical re-intervention is almost always indicated in these cases.…”

Section: Introductionmentioning

confidence: 99%

NIRS-based monitoring of kidney graft perfusion

et al. 2020

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Introduction Acute early vascular complications are rare, but serious complications after kidney transplantation. They often result in graft loss. For this reason, shortening the diagnostic process is crucial. Currently, it is standard procedure to monitor renal graft perfusion using Doppler ultrasound (DU). With respect to acute vascular complications, the main disadvantage of this type of examination is its periodicity. It would be of great benefit if graft blood perfusion could be monitored continuously during the early postoperative period. It appears evident that a well-designed near infrared spectroscopy (NIRS) monitoring system could prove very useful during the early post-transplantation period. Its role in the immediate diagnosis of vascular complications could result in a significant increase in graft salvage, thus improving the patient’s overall quality of life and lowering morbidity and mortality for renal graft recipients. The aim of this study was to design, construct and test such a monitoring system. Materials and methods We designed a rough NIRS-based system prototype and prepared a two-stage laboratory experiment based on a laboratory pig model. In the first stage, a total of 10 animals were used to verify and optimize the technical aspects and functionality of the prototype sensor by testing it on the animal kidneys in-vivo. As a result of these tests, a more specific prototype was designed. During the second stage, we prepared a unique laboratory model of a pig kidney autotransplantation and tested the system for long-term functionality on a group of 20 animals. Overall sensitivity and specificity were calculated, and a final prototype was prepared and completed with its own analytic software and chassis. Results We designed and constructed a NIRS-based system for kidney graft perfusion monitoring. The measurement system provided reliable performance and 100% sensitivity when detecting acute diminished blood perfusion of the transplanted kidneys in laboratory conditions. Conclusion The system appears to be a useful tool for diagnosing diminished blood perfusion of kidney transplants during the early postoperative period. However, further testing is still required. We believe that applying our method in current human transplantation medicine is feasible, and we are confident that our prototype is ready for human testing.

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Surgical Complications in Kidney Transplantation: An Overview of a Portuguese Reference Center

Cited by 23 publications

References 13 publications

Identifying Early Extraperitoneal High-Volume Urine Leak Post Kidney Transplantation

Identifying Early Extraperitoneal High-Volume Urine Leak Post Kidney Transplantation

Urološke komplikacije nakon transplantacije bubrega – iskustvo Referentnog centra u Hrvatskoj

NIRS-based monitoring of kidney graft perfusion

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