BACKGROUND Because of the shortage of deceased donor kidneys, some patients are on dialysis for over 10 years before renal transplantation. Many of these patients are anuric. We reviewed the urological complications in renal transplant recipients with anuria on hemodialysis for more than 10 years, compared with preemptive transplant recipients. METHODS The records of 4012 renal transplants from January 1988 to September 2007 were retrospectively reviewed. A total of 2735 deceased donor transplants were performed during this period. We identified a group of patients who were on hemodialysis for over 10 years and made less than 500 mL of urine per day. We compared the rate of urologic complications in this group with patients who were never on dialysis and had normal bladder function based on history and physical examination. RESULTS Seventy-two patients met the strict inclusion criteria. There were 41 recipients in the anuric group and 31 recipients in the preemptive group. The surgical complications were not significantly different between the two groups (P=0.503). However, the anuric group required five more hospital admissions for complicated urinary tract infections (P=0.044). CONCLUSIONS Renal transplant recipients who have been anuric for a prolonged period have higher rates of complicated urinary tract infections, but the long-term risks of urological complications are not significantly different.

AIM The incidence of urologic complications after renal transplantation has been reported to be between 2.5% and 27%. The aim of this study was to evaluate urologic complications of and their surgical treatment in our series of renal transplantations. MATERIALS AND METHODS We retrospectively evaluated urologic complications among 395 renal transplant recipients in our institute. RESULTS The urologic complications were ureteral leakage (n = 8), stricture of ureteral anastomosis (n = 3), hydronephrosis secondary to stone (n = 2) and bladder outlet obstruction (n = 2), recurrent urinary infection because of vesicoureteral reflux to native kidney (n = 2), renal tumor in native kidney (n = 1), hydroceles (n = 3), technical complications (n = 2), and clot retention (n = 1). CONCLUSION Major urologic complications following renal transplantation are ureteral leakage and stricture resulting from disrupture of the distal ureteral blood supply during the donor operation. Extravesical ureteroneocystostomy over a JJ stent seems feasible to minimize urologic complication. Early diagnosis and endourologic techniques are the mainstays of treatment.

Renal allograft thrombosis can cause transplant failure. Because antiphospholipid antibodies (aPA) are associated with thrombosis, we investigated pretransplant sera from patients with early renal allograft failure to determine if aPA were present. Fifty-six final cross-match (FxM) sera from patients whose transplant failed within 16 days were compared to FxM sera from the next sequential transplant patients. The sera were tested for IgG, IgM, and IgA antibodies to cardiolipin, phosphatidylserine, and phosphatidylethanolamine. aPA were identified in 57% of FxM sera from patients with early non-function versus 35% of FxM sera from patients with functioning grafts (P = 0.02). Historical sera from 11 aPA-positive patients contained aPA up to 18 months prior to transplantation. Since aPA were present in historical sera, testing for aPA can identify certain patients at risk for early allograft failure. The involvement of aPA in early allograft loss is supported by studies demonstrating aPA recovery from an explanted failed transplant.

Kidney dysfunction is a recognized complication after non-renal solid organ transplantation, particularly after intestinal transplant. In our study, we reviewed data on 33 multivisceral transplant (MVT)- and 15 isolated small bowel (ISB)-transplant patients to determine risk factors for kidney dysfunction. Kidney function was estimated by modified diet in renal disease (MDRD) and Schwartz formula for adults and children, respectively. Acute kidney injury (AKI) was defined as an increase in the serum Cr (sCr) greater than twofold. Kidney function declined significantly at one yr after transplantation with 46% of subjects showing an estimated GFR (eGFR)<60 mL/min. Patients with an episode of AKI were more likely to have reduced eGFR than those without AKI (p < 0.025). In linear regression analyses, age, pre-transplant sCr, eGFR at postoperative day (POD) 30, 90, 180, 270, and tacrolimus level at POD 7 showed significant correlation with one yr post-transplant eGFR (p < 0.05). Pediatric patients and patients with MVT had lesser decline in kidney function compared with adults or patients with ISB. In conclusion, risk factors for post-transplant kidney dysfunction in intestinal transplantation included age, pre-transplant sCr, AKI episode, eGFR at POD 30, 90, 180, 270, and tacrolimus level at POD 7.

Histidine-tryptophan-ketoglutarate solution (HTK) has been scrutinized for use in pancreas transplantation. A recent case series and a United Network for Organ Sharing data base review have suggested an increased incidence of allograft pancreatitis and graft loss with HTK compared to the University of Wisconsin solution (UW). Conversely, a recent randomized, controlled study failed to show any significant difference between HTK and UW for pancreas allograft preservation. This study was a retrospective review of all pancreas transplants performed at Indiana University between 2003 and 2009 comparing preservation with HTK or UW. Data included recipient and donor demographics, 7-day, 90-day and 1-year graft survival, peak 30-day serum amylase and lipase, HbA1c and C-peptide levels. Of the 308 pancreas transplants, 84% used HTK and 16% UW. There were more SPK compared to pancreas after kidney and pancreas transplant alone in the HTK group. Donor and recipient demographics were similar. There was no significant difference in 7-day, 90-day or 1-year graft survival, 30-day peak serum amylase and lipase, HbA1c or C-peptide. No clinically significant difference between HTK and UW for pancreas allograft preservation was identified. Specifically, in the context of low-to-moderate flush volume and short cold ischemia time (</=10 h), no increased incidence of allograft pancreatitis or graft loss was observed.

Early pancreas allograft failure most commonly results from thrombosis and requires immediate allograft pancreatectomy. Optimal timing for retransplantation remains undefined. Immediate retransplantation facilitates reuse of the same anatomic site before extensive adhesions have formed. Some studies suggest that early retransplantation is associated with a higher incidence of graft loss. This study is a retrospective review of immediate pancreas retransplants performed at a single center. All cases of pancreas allograft loss within 2 weeks were examined. Of 228 pancreas transplants, 12 grafts were lost within 2 weeks of surgery. Eleven of these underwent allograft pancreatectomy for thrombosis. One suffered anoxic brain injury and was not a retransplantation candidate, one was retransplanted at 3.5 months and nine patients underwent retransplantation 1-16 days following the original transplant. Of the nine early retransplants, one pancreas was lost to heparin-induced thrombocytopenia, one recipient died with function at 2.9 years and the other grafts continue to function at 76-1137 days (mean 572 days). One-year graft survival for early retransplantation was 89% compared to 91% for all pancreas transplants at our center. Immediate retransplantation following pancreatic graft thrombosis restores durable allograft function with outcomes comparable to first-time pancreas transplantation.

UNLABELLED Orthotopic liver transplantation (OLT) has historically been associated with massive blood loss and hemodynamic instability related to the coexistence of varices, coagulopathy, thrombocytopenia, and portal hypertension. Piggyback hepatectomy (PGB) is a technique increasingly utilized in OLT to avoid veno-venous bypass and vena cava clamping. This study evaluated the factors associated with blood loss and blood product requirement in PGB. METHODS This study is a retrospective review of the anesthesia preoperative and operative notes and computerized lab values for all adult cadaveric liver transplants over a 42-month period. These data were combined with the liver transplant database for analysis. Approximately 98% of the transplants were performed using a standard piggyback approach with no use of veno-venous bypass. RESULTS Data were included for all 526 transplants performed during this time period. Estimated blood loss (EBL) was 1000 cc. Median transfusion requirement was 3 units packed red blood cells, 7 units fresh frozen plasma, and 6 units platelets. Multivariate linear regression demonstrated that predictors of EBL were age, MELD score, preoperative hemoglobin, initial fibrinogen, initial central venous pressure, and total anesthesia time. Predictors of PRBC useage were age, MELD score, preoperative hemoglobin, initial fibrinogen, and anesthesia time. Postoperatively increased transfusion requirement was associated with increased length of hospital stay and lower 90-day and 1-year graft and patient survivals. CONCLUSION These results demonstrate that PGB can be safely accomplished in nearly all liver transplant patients without venovenous bypass or vena cava clamping and with less warm ischemia, which may ultimately be associated with less perioperative morbidity and improved outcomes.

Carbon nanotubes produced in arcs have been found to have the form of multiwalled fullerenes, at least over short lengths. Sintering of the tubes to each other is the predominant source of defects that limit the utility of these otherwise perfect fullerene structures. The use of a water-cooled copper cathode minimized such defects, permitting nanotubes longer than 40 micrometers to be attached to macroscopic electrodes and extracted from the bulk deposit. A detailed mechanism that features the high electric field at (and field-emission from) open nanotube tips exposed to the arc plasma, and consequent positive feedback effects from the neutral gas and plasma, is proposed for tube growth in such arcs.

Disseminated invasive aspergillosis is a serious and potentially lethal infectious complication of immunosuppressed individuals, including transplant recipients. We report here a successfully treated case of disseminated Aspergillus fumigatus infection involving the lungs, brain, and endocardium in a multivisceral transplant recipient. In addition to supportive measures, the patient was aggressively treated with a combination of three antifungal agents, and all immunosuppression was significantly lowered with close observation for rejection. After 3 months of therapy, the patient cleared the fungal infection, made a full recovery of his cerebral function, and was discharged to a rehabilitation facility.

We track individual twin boundaries in Ag films on Ru(0001) using low-energy electron microscopy. The twin boundaries, which separate film regions whose close-packed planes are stacked differently, move readily during film growth but relatively little during annealing. The growth-driven motion of twin boundaries occurs as film steps advance across the surface--as a new atomic Ag layer reaches an fcc twin boundary, the advancing step edge carries along the boundary. This coupling of the microstructural defect (twin boundary) and the surface step during growth can produce film regions over 10 microm wide that are twin free.

BACKGROUND Our aim is to identify the incidence of urologic complications in adult renal transplantation comparing two different ureterovesical anastomosis techniques, the Taguchi (T) and Lich-Gregoire (LG). MATERIAL/METHODS Retrospective analysis of adult renal transplants performed at the MUHC between 2000-2009. Excluded: multi-organ transplants, re-do transplants, variant ureteric anastomosis and patients received grafts from UNOS ECD. 372 patients were analyzed. 209 patients (56%) in the T group and 163 patients (44%) in the LG group. Fisher's exact test was used to compare the groups for urologic complications. A multivariate analysis was performed to identify factors associated with graft rejection and death. RESULTS 21 patients developed a urinary leak or stricture. A total of 13 patients (3.4%) developed ureteric strictures and 9 (2.4%) patients developed urinary leak with no difference in urinary leak or stricture between both groups (p=1). Hematuria requiring intervention developed in 55 patients. A higher incidence of complicated hematuria in the T group when compared to the LG group (37 vs. 18, p=0.079)). No differences in other ureteric complications between the 2 groups. Delayed graft function OR=3.4 (95% CI=1.8-6.3) and grafts from a deceased donors OR=2.2 (95% CI=1.1-4.5) are factors associated with graft loss. Factors associated with first episode of rejection include delayed graft function OR=2.4 (95% CI=1.3-4.4), and the development of ureteric stricture OR=3.9 (95% CI=1.8-8.7). CONCLUSIONS Both techniques can be used interchangeably for adult renal transplantation. T technique is associated with a greater risk of hematuria. Ureteric strictures are associated with a shorter time to first graft rejection.

We report our urologic complications based on one urologist's experience during a 17-year period on more than 2500 ureteral reimplantation operations performed at the time of kidney transplant. Among 2548 ureteroneocystostomies performed by the transplant urologist, a 5.5% urologic complication rate was observed. This included vesicoureteral reflux (3%), ureteral strictures (1.3%), urine leak (0.9%), and uteropelvic junction obstruction (0.3%). The factors for low urologic complication rates include the use of a shorter segment of ureter using the Lich-Gregoir technique (compared to the Politano-Leadbetter technique) and the routine use of indwelling stents. In addition, having one transplant urologist performing all ureteral reimplantations and managing all urologic complications provided consistency in results.

Despite a variety of urinary tract reconstructive techniques, urinary complications are the most frequent technical adverse event following renal transplantation. These complications can be associated with substantial morbidity and generate excess cost. In this review we comprehensively discuss 4 techniques of ureteroneocystostomy, compare complications, and evaluate the strengths and weaknesses of each technique focusing on 4 specific urologic complications: urine leak, ureteric obstruction, hematuria, and symptomatic vesicoureteral reflux.

Surgical complications remain a significant clinical problem following renal trans-plantation. Ureteral obstruction following transplantation is not uncommon. Persistent obstruction of the ureterovesical anastomosis is the most common urologic complication. Obstruction occurring beyond the first post operative month remains frequent (2-7.5%) and mostly related to ureteral stenosis. We report here a case of ureteral stenosis due to an unusual cause and review the literature.

To determine age-related risk factors of urological and vascular complications. We performed a retrospective analysis of the data of 202 renal transplantations in 193 children between 1989 and 2007 at a single institution. Out of 193 grafts (combined renal and liver grafts were excluded), we observed urological complications in 42 cases (21.7%) leading to graft loss in one case and vascular complications in 27 cases (13.9%) leading to graft loss in seven. The urological complications were VUR (n=25, 12.4%), ureteral stricture (n=10, 5%), anastomotic leak (n=4, 2%), ureteral necrosis (n=2, 1%), and incrustative pyelitis (n=1, 0.5%). Vascular complications were arterial stricture (n=14, 7.2%), arterial thrombosis (n=4, 2%), venous thrombosis (n=2, 1%), and others (n=7). Donors aged less than six yr were a risk factor of vascular complications leading to graft loss (p=0.0001), whereas patients with PUV had more urological complications (p=0.001). Overall patient and graft survival is 93.1% and 84% at five yr, respectively. Surgical complications remain a major cause of graft loss (12%) and morbidity in children's kidney transplantation (38.9%). Young age of donors is the major risk factor of early graft loss as a result of vascular complication. However, donor selection based on age is limited by the shortage of organs.

The aim of the present study was to analyze the effects of ureteral stents used in renal transplantation on urologic as well as other complications. Cases of renal transplants from living or deceased donors performed in our hospital were retrospectively evaluated. The effects of the routine use of ureteral stents on postoperative complications were investigated. All outcomes and complications encountered during the postoperative follow-up were recorded. The Lich-Gregoire technique, which is a method of extravesical ureteroneocystostomy, was performed on all patients. One hundred and twenty-two patients underwent renal transplantation between 2001 and 2007 in our hospital. Stents were placed routinely in all patients. Leakage was observed in one patient, and one patient developed an obstruction; however, none of the patients developed an infection. A lymphocele developed in one patient. All urologic complications were treated without major morbidity. Graft loss did not occur. Complications following urinary anastomosis have a high rate of morbidity in renal transplantation. Ureteral stenting in renal transplant recipients prevents early urologic complications. The data generated in the current study were compared to the literature.

OBJECTIVE To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis. PATIENT AND METHODS From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment. RESULTS Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy (n = 21) or after Politano-Leadbetter anastomosis (n = 22). The success rate of endoscopic management was 75%(n = 16) for Politano-Leadbetter anastomosis versus 53%(n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference (P =.1). CONCLUSION Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.

BACKGROUND Urologic complications cause substantial morbidity in the pediatric population after renal transplantation, but their impact on graft survival and transplant costs is poorly understood. In this retrospective review, we evaluated the records of all pediatric renal transplant recipients at our center from 1995 to 2004. METHODS Patient demographics, presence of urinary leak, stricture, compression, or vesicoureteral reflux, and hospital costs were analyzed. Univariable analysis identified predictors of complications and of need for reoperation, and Kaplan-Meier analysis was used to assess graft survival in relation to urinary complications. RESULTS One hundred forty-seven children received renal transplants; mean follow-up was 1478+/-965 days. Nine (6.1%) patients had urologic complications and seven (4.8%) patients developed vesicoureteral reflux requiring reoperation. Sex, ischemia time, race, previous transplant, donor type, nephrectomy technique, and stent use did not affect the incidence of urologic complications. Previous urologic reconstruction and pretransplant ureteral pathologic conditions increased the risk of urologic complication and vesicoureteral reflux. Patients with urologic complications had equivalent graft survival, but triple the hospital costs of unaffected recipients. CONCLUSIONS Prior urologic surgery is associated with increased risk of urologic complications posttransplant. Posttransplant urologic complications are associated with substantially increased costs in the first year after transplant, but not with decreased graft survival.

AIM The incidence of urologic complications after renal transplantation has been reported to be between 2.5% and 27%. The aim of this study was to evaluate urologic complications of and their surgical treatment in our series of renal transplantations. MATERIALS AND METHODS We retrospectively evaluated urologic complications among 395 renal transplant recipients in our institute. RESULTS The urologic complications were ureteral leakage (n = 8), stricture of ureteral anastomosis (n = 3), hydronephrosis secondary to stone (n = 2) and bladder outlet obstruction (n = 2), recurrent urinary infection because of vesicoureteral reflux to native kidney (n = 2), renal tumor in native kidney (n = 1), hydroceles (n = 3), technical complications (n = 2), and clot retention (n = 1). CONCLUSION Major urologic complications following renal transplantation are ureteral leakage and stricture resulting from disrupture of the distal ureteral blood supply during the donor operation. Extravesical ureteroneocystostomy over a JJ stent seems feasible to minimize urologic complication. Early diagnosis and endourologic techniques are the mainstays of treatment.

Urological complications in 211 consecutive primary and secondary cadaveric renal transplants, performed t our institution between March 1993 and December 1996, were encountered in 13 patients (6.2%). The complications included urine leakage in four cases (1.9%)., obstruction of the upper urinary tract in seven (3.3%), urethral strictures in two (1%) and stone formation in one. Successfully treated complications amounted to 86%. Associated infection and urinary leak resulted in the loss of two grafts.