This 5 year observational multicentre study conducted in the Nord Italian Transplant programme area evaluated outcomes in patients receiving kidneys from donors over 60 years allocated according to a combined clinical and histological algorithm. Low-risk donors 60-69 years without risk factors were allocated to single kidney transplant (LR-SKT) based on clinical criteria. Biopsy was performed in donors over 70 years or 60-69 years with risk factors, allocated to Single (HR-SKT) or Dual kidney transplant (HR-DKT) according to the severity of histological damage. Forty HR-DKTs, 41 HR-SKTs and 234 LR-SKTs were evaluated. Baseline differences generally reflected stratification and allocation criteria. Patient and graft (death censored) survival were 90% and 92% for HR-DKT, 85% and 89% for HR-SKT, 88% and 87% for LR-SKT. The algorithm appeared user-friendly in daily practice and was safe and efficient, as demonstrated by satisfactory outcomes in all groups at 5 years. Clinical criteria performed well in low-risk donors. The excellent outcomes observed in DKTs call for fine-tuning of cut-off scores for allocation to DKT or SKT in high-risk patients.

Objective: Urinary infections developing after kidney transplantation may depend on the type of ureterovesical anastomosis performed. Patients and Methods: A randomized prospective study was performed on 56 patients, from October 2004 to March 2006, receiving kidney transplants from cadaveric donors to compare 2 types of ureterovesical anastomosis. We considered the number and types of urinary infections, the duration of their treatment, and their complete/ partial resolution during the first year after transplantation. Twenty-eight patients (group A) underwent ureterovesical anastomosis according to the Lich-Gregoir technique, the other 28 patients (group B) using the Knechtle method. The 2 groups were comparable in terms of donor and recipient characteristics. Results: The mean duration of the period of antibiotic treatment was 17 ± 11 days in group A and 15 ± 7 days in group B (p = 0.63), while the intravenous antibiotic treatment lasted a mean 11 ± 6 days in group A and 10 ± 3 days in group B (p = 0.54). The antibiotic treatment completely resolved the urinary infection in all cases treated. No grafts were lost due to complications of urinary infections. Conclusion: Our data revealed no statistically significant differences between the 2 types of ureterovesical anastomosis considered in terms of the prevalence of infections or graft survival during the first year of follow-up.

Aims The development of new effective immunosuppressive agents has provided long-term survival for transplant recipients, thereby increasing the risk of de novo malignancy in chronic immunocompromised hosts. Although de novo post-transplant lymphoproliferative diseases and skin cancer have been shown to have an increased incidence in long-term surviving solid organ transplant recipients, the association with colon cancer is controversial. Patients and methods Over a 12-year period, 20 patients (5%) out of 400 renal transplant recipients (treated at the University Hospitals of Udine and Ancona) developed 24 de novo tumors; 11 skin cancers and 13 non-skin cancers. Three patients developed de novo colon cancer. Immunosuppressive therapy was reduced immediately after diagnosis, and all patients were shifted from cyclosporine to rapamicine within 30 days. The tumor was surgically resected with curative intent in 2 cases, and 1 patient had only palliative surgery due to metastatic disease. The postoperative course was uneventful, and all patients maintained normal graft function. Results Two of 3 patients died of progression of the neoplasm, within a median time from the diagnosis of 12 months. We analyzed the possible correlations between de novo colon cancer and “serology (hepatitis C virus-hepatitis B virus, HCV-HBV) status'’ infections, cytomegalovirus and Epstein-Barr virus reactivation, episodes of rejection, and blood transfusions. Conclusions Differently from other de novo skin and non-skin tumors, our cases developed cytomegalovirus and Epstein-Barr virus reactivation within 3 months of transplantation. Therefore, we suggest a closer follow-up for de novo colon cancer in renal transplants with early cytomegalovirus and Epstein-Barr virus reactivation in order to avoid a delay in diagnosis.