Introduction. - In the current context of a high incidence end-stage kidney disease and a shortage of organs for kidney transplantation, the increasing use of transplants considered to be "borderline" represents a potential source of transplants. Over the last 10 years, some centers have developed a transplantation strategy, which consists of transplanting two borderline kidneys that cannot be proposed separately in a single recipient. The authors report their experience of dual kidney transplant.Materials and methods. - Since 2001, 15 dual kidney transplants have been performed in a single centre according to a local protocol based on the correspondence between the weight of the donor kidney and the recipient's weight, weighted by the number of fibrotic glomeruli observed on the initial biopsy. In this study, the authors analyze the postoperative complications and functional results observed in patients transplanted according to this protocol.Results. - Dual kidney transplants represented less than 5% of all transplants performed during the study period concerned, which remained tower than the objectives initially announced by the ABM. The surgical technique was left to the surgeon's discretion. The mean follow-up was 26.3 months. Fourteen of the 15 recipients were alive with a functional graft. Surgical complications were globally more frequent when kidneys were transplanted on the same side (versus transplanted on both sides). Mean serum creatinine was 119.4 mol/l. at six months (creatinine clearance according to MDRD formula: 57.3ml/min per 1.73 m(2)), 118.8mol/l at 12 months (creatinine clearance: 55.8) and 132.4 mol/l at 24 months (creatinine clearance: 44.2). One year post-transplant, mean renal function measured by inulin clearance was 55.5 ml/min per 1.73 m(2). Four of the 15 patients had experienced an episode of acute rejection and three patients experienced delayed return of transplant function.Conclusion. - In view of the results obtained, the authors consider that dual kidney transplant could be a reasonable and effective option for selected patients. Positioning of the transplants in each itiac fossa limited the surgical complication rate. (c) 2008 Elsevier Masson SAS. Tous droits reserves.

Badet, L; Petruzzo, P; Lefranois, N; Colombel, M; Dawahra, M; Fassi-Fehri, H; Dubernard, J M; Martin, X Author Information

Objective: Objective of this study was to analyze fifteen months after. surgery the sensorimotor recovery of the first human double hand transplantation.Summary Background Data: As for any organ transplantation the success of composite tissue allografts such as a double hand allograft depends on prevention of rejection and its functional recovery.Methods: The recipient was a 33-year-old man with bilateral amputation. Surgery included procurement of the upper extremities from a multiorgan cadaveric donor, preparation of the graft and recipient's stumps; then, bone fixation, arterial and venous anastomoses, nerve sutures, joining of tendons and muscles and skin closure. Rehabilitation program included physiotherapy, electrostimulation and occupational therapy. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil and, for induction, antithymocyte globulins and then CD25 monoclonal antibody were added. Sensorimotor recovery tests and functional magnetic resonance imaging (fMRI) were performed to assess functional return and cortical reorganization. All the results were classified according to Ipsen's classification.Results: No surgical complications occurred. Two episodes of skin acute rejection characterized by maculopapular lesions were completely reversed increasing steroid dose within 10 days. By fifteen months the sensorimotor recovery was encouraging and the life quality improved. fMRI showed that cortical hand representation progressively shifted from lateral to medial region in the motor cortex.Conclusion: Even though at present this double hand allograft, treated using a conventional immunosuppression, allowed to obtain results at least as good as those achieved in replanted upper extremities, longer follow-up will be necessary to demonstrate the final functional restoration.

This new book, edited by internationally renowned specialists, also pools the experience of consultants from both Europe and the US. It is divided into three main sections: Organ Preservation, Organ Harvesting and Surgical Techniques. Many different organs are profiled, including the heart, kidneys, lungs, pancreas, intestine and bowel. The various

The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts’ recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.

AIM:To evaluate the feasibility of splitting a liver graft for transplantation in two adult patients.PATIENTS AND METHODS:We retrospectively collected data on the harvesting of 100 consecutive liver grafts. Data were separated into 4 groups to establish feasibility criteria, according to the chronological steps of harvesting: 1) initial criteria about the donor (age, weight, biological tests), 2) criteria concerning the liver graft at the time of harvesting (macroscopic appearance, graft weight, hemodynamic state of donor), (3) anatomical criteria and (4) histological criteria.RESULTS:If our criteria for the feasibility of splitting a liver graft for transplantation in two adults had been applied, 47 grafts would have been rejected based on initial criteria, 34 at the time of harvesting and 6 because of anatomical or histological evaluation. Finally, 13 liver grafts would have been accepted for splitting and then transplantation in two adults.CONCLUSIONS:Split-liver transplantation for two adult recipients could increase the graft pool by 13%. This procedure requires technical changes in organ harvesting and coordination among centers.

Experimentation (. . .) is justified primarily by the individual’s and not by the community’s interest. However, this does not exclude that, provided that one’s own substantial integrity is preserved, the patient could legitimately bear a part of the risks to contribute with his/her initiative to the progress of medicine, and in this way, to the welfare of the community. Within the community, the purpose of medicine is to free the human being from the infirmities that block him, and from the psycho-somatic fragilities that humiliate him John Paul II From the address to the participants to two surgical meetings in Rome, Italy October 27, 1980

L’innovation est-elle rupture du mode de pensée, briseuse de tabous, concrétisation de chimères ou simple fruit d’une évolution inéluctable ? L’acte chirurgical n’est-il pas par définition posture d’innovation ? Appliquée à la première greffe du visage, l’innovation se décline à tous les modes, répond à toutes ses définitions qu’il s’agisse du temps de la maturation, celui de la revascularisation et des multiples développements qui ont été menés depuis. C’est dans ce sens que l’on appliquera volontiers au mot le qualificatif d’archétypique.Is innovation breaking of the way of thinking, breaker of taboos, concretisation of chimeras or simple benefit of an ineluctable evolution? The surgical act should be considered as innovation itself? From the first facial allotransplantation, innovation is declined in various ways, which could constitute the different answers regarding the planning and management to prepare such surgery, the realisation of the transplantation and also the multiple developments in terms of science and medicine. It is exactly in that meaning that could be really mentioned the term archetypal.

The pheochromocytoma is a medullo-adrenal tumor which develops at the cost of the chromaffin cells. It appears in 11-19% of cases of von Hippel-Lindau's disease (VHL), is often bilateral, and the symptomatology is often crude: arterial hypertension is frequently isolated and unstable, and the classic triad of headache, palpitations and sweating is quite rarely observed. We report four observations of bilateral pheochromocytomas in patients with von Hippel-Lindau's disease (three with phenotype IIA and one with phenotype IIB). The tumor was bilateral during the diagnosis in three cases; in the fourth patient, the attack on the contralateral adrenal gland came two years after the first adrenalectomy. All the patients had undergone an adrenalectomy by open surgery after a short preparation of 48 hours; replacement therapy was begun in each patient. Morbidity was low, and the patients submitted to a prolonged follow-up in order to screen for the onset of future lesions of VHL.

The pheochromocytoma is a medullo-adrenal tumor which develops at the cost of the chromaffin cells. It appears in 11-19% of cases of von Hippel-Lindau's disease (VHL), is often bilateral, and the symptomatology is often crude: arterial hypertension is frequently isolated and unstable, and the classic triad of headache, palpitations and sweating is quite rarely observed. We report four observations of bilateral pheochromocytomas in patients with von Hippel-Lindau's disease (three with phenotype IIA and one with phenotype IIB). The tumor was bilateral during the diagnosis in three cases; in the fourth patient, the attack on the contralateral adrenal gland came two years after the first adrenalectomy. All the patients had undergone an adrenalectomy by open surgery after a short preparation of 48 hours; replacement therapy was begun in each patient. Morbidity was low, and the patients submitted to a prolonged follow-up in order to screen for the onset of future lesions of VHL. (C) 2001 Editions scientifiques et medicales Elsevier SAS.

We report the case of a 48 year-old woman presently with a pararenal tumor, with a history of pyelotomy in 1978 for the extraction of a renal pelvic stones. Results of surgery showed a foreign body. The clinical and diagnostic aspects of retained surgical gauze have been discussed and the need for radio-opaque markers in them have been emphasized.

We report the case of a 48 year-old woman presently with a pararenal tumor, with a history of pyelotomy in 1978 for the extraction of a renal pelvic stones. Results of surgery showed a foreign body. The clinical and diagnostic aspects of retained surgical gauze have been discussed and the need for radio-opaque markers in them have been emphasiezd. (C) 2001 Editions scientifiques et medicales Elsevier SAS.