AUA 2006 - UCI Review: Renal Transplantation: Renal Vascular Surgery (I) PODIUM

Main Category: Transplants / Organ Donations
Also Included In: Urology / Nephrology
Article Date: 12 Jun 2006 - 0:00 PDT

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UroToday.com - Dr. Alexandra Perks and the group from St. Michael's Hospital in Toronto, Canada, presented their experiences with Canadian nationals who had undergone renal transplantation procedures in countries outside continental North America and Western Europe and then presented to their institution. They identified 22 cases of commercial transplantation from living unrelated donors in 20 patients who were transplanted between 1999 and 2005, 2 of whom had received their second commercial transplant. Ninety five percent of these persons were landed immigrants in Canada at the time of transplantation and the procedures were conducted in Pakistan (9), China (5), Iran (3) and 1 each in Turkey and the Philippines. Seventy seven percent returned to Canada with documentation of the procedure and 7 of 22 required immediate hospital admissions. There was a 27 % rate of rejection and 52 % developed severe infections. The 1 year patient and graft survival was 90 % and 82 % respectively. Importantly 2 patients died of systemic infections and 1 died of metastatic malignancy. 10 of the 22 grafts continue to function well. This is a significant issue that undoubtedly will be escalated by the ever present organ shortages. These issues should continue to receive the utmost attention by transplant societies and surgeons worldwide.

Log-term comparative outcomes of ureteroneocystostomy techniques in renal transplantation. Jeffrey Veale, Jay Yew, David Gjertson, Gabriel Danovitch, Alan Wilkinson, Phuong-Thu Pham, J. Thomas Rosenthal, H. Albin Gritsch.

Dr. Jeffrey Veale and the group from UCLA led by Dr. H. Albin Gritsch reviewed their large experience with 2 types of ureteroneocystostomy, namely the Lich-Gregoir and Shanfield techniques. Between 1999 and 2002 they evaluated 713 transplants of which 360 had a Lich-Gregoir vs. 353 having the Shanfield reimplant. They found that the Shanfield group had a 14.2 % vs. 3.9 % (p- value 0.0001) complication rate in the Lich-Gregoir. These consisted of more ureteric leaks, hematuria, ureteric strictures and stones. There was no difference in UTI, delayed graft function or rejection rates between the two groups. At this large transplant institution they recommend the Lich-Gregoir ureteral reimplant.

Moderators: Dr. Mark K. Plante and Dr. Geoffrey N. Sklar

Commercial Renal Transplantation: A Canadian Experience. Ashutosh M. Shukla, Alexandra E. Perks, Luke M. Fazio, Kenneth T. Pace, Robert S. Stewart, Gv Ramesh Prasad, R. John Honey.

By Leslie Deane, MD

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