We studied the complications of gallstone disease in kidney transplantation patients and evaluated whether the screening and treatment of gallstones before acceptance to the kidney waiting list is relevant.
Complications of gallstone disease were evaluated in 1608 kidney transplantation patients on cyclosporine and long-term steroid treatment with median age 45.5 years, transplanted between 1990 and 2000. To evaluate the prevalence of cholecystolithiasis after kidney transplantation an abdominal ultrasound examination was cross-sectionally performed to a subgroup of 304 patients and the results were correlated to their serum lipid values, changes in BMI and use of statins.
Pre-transplant cholecystectomy due to cholecystolithiasis (prerequisite for acceptance to kidney waiting list) had been performed on 71 (4%) of the patients. Thirty (15%) patients with diagnosed post-transplant gallstones and four without gallstones developed biliary complications. There were 25 cases of cholecystitis of which three resulted in gallbladder perforations. Seventeen patients (50%) with biliary complications required urgent surgery and one (3%) patient died of post-operative complications. In the subgroup of ultrasound examination patients (median 7 years post-transplant follow-up) 81% of the patients had no gallstones and 9% of the patients had gallstones had developed after transplantation. Patients with pre-transplant gallstones were older (P
1. The 5-year actuarial graft, patient and functional graft survival rates were analyzed in 743 consecutive primary cadaveric kidney transplants from The Toronto Hospital between January 1985-December 1997. 2. Recipient age > or = 55 years, male recipient sex, recipient diabetes mellitus, CIT > 36 hours and delayed graft function were found to significantly decrease patient survival. 3. Recipient age > or = 55 years, sensitization to HLA antigens (peak PRA > 50%), donor/recipient HLA antigen mismatches, CIT > 36 hours, delayed graft, function and 6-month SCr > 200 mumol/L were found to significantly decrease graft survival. 4. Acute rejection episodes had no significant impact on overall 5-year patient or graft survival. 5. The observation that serum creatinine > 200 mumol/L had a major adverse influence on long-term outcome reflects the importance of functional renal mass on graft survival.
Postoperative recovery often is assessed with parameters (pain and return to work) susceptible to bias. This study sought objectively to compare postoperative health-related quality of life (HRQL) after laparoscopic and open nephrectomy with the Postoperative Recovery (PRS) (a validated questionnaire designed to assess pain), activities of daily living (ADL), and HRQL in postoperative patients.
Patients undergoing contemporaneous laparoscopic and open nephrectomy received the PRS pre- and postoperatively. The results were analyzed with analysis of covariance (ANCOV) and survival analysis.
The 33 open nephrectomy and 38 laparoscopic patients in this study were comparable in age, gender, body mass index (BMI) and employment. Laparoscopic operative time was longer (p = 0.015), and the hospital stay was shorter (p
The Nordic Pediatric Renal Transplant Study Group was organized in 1994 to register and follow children under 16 years of age who receive renal allografts in the Nordic countries. It comprises all transplant centers in Scandinavia, four in Sweden, three in Denmark and one each in Norway and Finland. The following report is based on 430 transplantations performed in 1982-1996. 343 were first transplants and 57 were retransplants. The mean annual incidence of renal transplantations per million children below 16 years of age was 7.4. The mean incidence of retransplantations was 1.0 and therefore the mean incidence of primary transplantations was 6.5 per million children below 16 years of age. 12% of the children were less than 2 years of age, 20% 2-5 years of age and 68% 6-15 years of age. 231 (54%) of the transplants were performed with grafts from living-related donors (LD) and 199 (46%) with cadaveric grafts (CD). 72% of the children had congenital renal disorders and 28% acquired diseases. Cyclosporine-based immunosuppressive protocols were used in all centers. Antibody induction therapy (polyclonal or monoclonal) was used by only three of the nine participating centers. The mean 1-year graft survival rate for all age groups was 88% for recipients of living-donor grafts and 78% for recipients of cadaveric donor grafts.
In vivo and in vitro experiments were made to study percutaneous intrarenal ultrasonography (PIU). The transurethral ultrasonic probe (5.5 MHz, 1850 "Bruel&Kjer, Denmark) was inserted through the nephrostomic fistula in the dilated pelvis with the tubus of the nephroscope K. Storz 27093B. Scanning of the cavitary renal system and ureteropelvic zone was conducted by moving the probe in the longitudinal and transverse directions. The experiment on 21 removed kidneys investigated potentialities of PIU in hydronephrotic transformation caused by ureteropelvic stricture (4 kidneys), urolithiasis (7 kidneys), carcinoma of renal parenchyma (5 kidneys), pelvic cancer (1 kidney), combined renal cell and epithelial renal carcinoma (1 kidney); in pyonephrosis (1 kidney) and contracted kidney (2 kidneys). 43 patients (19 males and 24 females aged 7 to 63 years) have undergone PIU in the course of percutaneous nephrolithotripsy (n = 23), percutaneous endopyelotomy (n = 15) and percutaneous endoresection of solitary renal cyst (n = 5). PIU accurately localizes residual and x-ray-negative concrement fragments raising the effectiveness of percutaneous nephrolithotripsy, precisely differentiates internal renal structures, visualizes pelvic wall, vessels and tissues of the renal sinus, provides additional information about ureteropelvic zone and its changes. PIU can find wide application in intraoperative diagnosis of different renal and upper urinary tract diseases.
BACKGROUND. To study the influence of pre-conceptional health status and immunosuppressive drug regimen on pregnancy outcome in renal allograft recipients. METHODS. The study includes all pregnancies in renal allograft recipients in Norway in the period 1973-1991. The data were collected from the patient records. Serum-creatinine values, proteinuria, blood pressure, recent graft rejection, and immunosuppressive drug regimen before pregnancy as well as the interval from transplantation until pregnancy were related to the frequency of deliveries at term, preterm deliveries, and of induced and spontaneous abortions. RESULTS. 54 pregnancies in 37 renal allograft recipients resulted in 31 term deliveries, 12 preterm deliveries, four spontaneous, and seven induced abortions. One induced abortion due to psychosocial reasons was excluded from the calculations. Post-transplant intervals less than two years as compared to longer intervals were associated with an increased frequency of spontaneous and induced abortions (6/13 vs 4/40, p