Therapeutic Living Donor Nephrectomy for Proximal Ureteral Pathology: A Longitudinal Case Series

Freise, Jonathan; Nunez, Miguel; Chi, Thomas; Stoller, Marshall L.; Freise, Chris F.; Roll, Garrett R.

doi:10.1016/j.urology.2022.04.032

Cited by 1 publication

(5 citation statements)

References 7 publications

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“…11,12 Some patients also undergo prolonged treatment with analgesics for pain control. Because therapeutic nephrectomy is usually performed as a last resort after multiple procedures for underlying diseases, [2][3][4] subclinical structural and functional damage to the renal parenchyma or vasculature may exist in some TD kidney allografts even with apparently normal eGFR.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from our study, current literature on TD-KT is limited to 3 published case series/ reports consisting of 12 TDs with loin pain hematuria syndrome, ureteral abnormalities/injuries, nutcracker syndrome, or unilateral renal mass, with all cases reporting excellent graft function. [2][3][4] Beyond these limited reports, however, prior studies of kidney autotransplantation may help elucidate risks because the indications for kidney autotransplantation and possible TD-KT often overlap. In kidney autotransplantation, the affected kidney is removed, repaired/prepared on the back table in the operating room, and then reimplanted into the same patient, usually in the pelvis.…”

Section: Discussionmentioning

confidence: 99%

“…Mean ± SD eGFR values at 6 and 12 mo posttransplant were also similar between the TD-KT and non-TD-LD-KT groups (59.9 ± 20.7 versus 63.3 ± 17.9 mL/min/1.73 m 2 at 6 mo, P = 0.35; 60.6 ± 18.2 versus 65.7 ± 19.6 mL/min/1.73 m 2 at 12 mo, P = 0.77). Compared with TD-KT recipients, DD-KT recipients had significantly longer median LOS (4 [3][4][5] versus 5 [4][5][6][7][8] d, P < 0.001) and a higher DGF rate (3% versus 20%, P = 0.012). However, posttransplant eGFR values were similar between the TD-KT and DD-KT groups (59.9 ± 20.7 versus 59.9 ± 23.0 mL/min/1.73 m 2 at 6 mo, P = 0.48; 60.6 ± 18.2 versus 62.5 ± 22.4 mL/min/1.73 m 2 at 12 mo, P = 0.96).…”

Section: Recipient Outcomesmentioning

confidence: 95%

“…Available reports have been single-center experiences of transplanting small numbers of kidneys from patients who had undergone nephrectomy for medical conditions refractory to other therapies, including ureteral abnormalities, loin pain hematuria syndrome, and nutcracker syndrome. [2][3][4] The reported posttransplant recipient outcomes of these TD-KTs have been described as generally acceptable; however, they have not been systematically compared with more typical KT from living or deceased donors (DDs). TD-KT recipients may have inferior graft function compared with usual KT recipients due to the underlying disease processes and/or prenephrectomy interventions in the TD that may have damaged the kidney, such as ureteral obstruction, vascular interventions, nephrostomy, and long-term use of analgesics.…”

mentioning

confidence: 99%

“…TD-KT recipients may have inferior graft function compared with usual KT recipients due to the underlying disease processes and/or prenephrectomy interventions in the TD that may have damaged the kidney, such as ureteral obstruction, vascular interventions, nephrostomy, and long-term use of analgesics. 3,5,6 Given these potential differences, it is important to understand TD-KT outcomes in relation to non-TD-KT to help guide shared decision-making with potential recipients, promote effective utilization of these kidneys, and assess the potential effect on performance measures for centers that utilize TDs as living donors.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Therapeutic Donor Kidney Transplant Outcomes: Comparing Early US Experiences Using Optimal Matching

Yamauchi,

Raghavan,

Rofaiel

et al. 2023

Transplantation Direct

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Background. Therapeutic donors (TDs) are individuals who undergo organ removal for medical treatment with no replacement organ, and the organ is then transplanted into another person. Transplant centers in the United States have started using TDs for kidney transplantation (KT). TD-KT recipient outcomes may be inferior to those of non-TD-living-donor (non-TD-LD)-KT or deceased-donor (DD)-KT because of the conditions that led to nephrectomy; however, these outcomes have not been sufficiently evaluated. Methods. This was a retrospective cohort study using Organ Procurement and Transplantation Network data. Via optimal matching methods, we created 1:4 fivesomes with highly similar characteristics for TD-KT and non-TD-LD-KT recipients and then separately for TD-KT and DD-KT recipients. We compared a 6-mo estimated glomerular filtration rate (eGFR) between groups (primary endpoint) and a composite of death, graft loss, or eGFR <30 mL/min/1.73 m2 at 6 mo (secondary). Results. We identified 36 TD-KT recipients with 6-mo eGFR. There was also 1 death and 2 graft losses within 6 mo. Mean ± SD 6-mo eGFR was not significantly different between TD-KT, non-TD-LD-KT, and DD-KT recipients (59.9 ± 20.7, 63.3 ± 17.9, and 59.9 ± 23.0 mL/min/1.73 m2, respectively; P > 0.05). However, the 6-mo composite outcome occurred more frequently with TD-KT than with non-TD-LD-KT and DD-KT (18%, 2% [P < 0.001], and 8% [P = 0.053], respectively). Conclusions. Early graft function was no different between well-matched groups, but TD-KT demonstrated a higher risk of otherwise poor 6-mo outcomes compared with non-TD-LD-KT and DD-KT. Our results support selective utilization of TD kidneys; however, additional studies are needed with more detailed TD kidney information to understand how to best utilize these kidneys.

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