Over the past half a century, kidney transplants have increased significantly and more patients that are elderly are receiving kidney transplants. As a result, the eligibility of patients with prostate cancer who wish to receive a kidney transplant has become a significant issue facing the transplant community. Many questions have arisen because prostate cancer is an extremely variable disease that many times do not harm the patients but at other times, can cause the death of the patient.

Posttransplant lymphoproliferative disorder with involvement of the donor urogenital tissue is a rare and serious complication of solid organ transplant. We report an adult kidney transplant recipient who developed the diffuse large B cell lymphoma of the distal ureter in the setting of new allograft nephropathy. Early intervention, reduction of immunosuppression, surgical reconstruction and chemotherapy salvaged the allograft kidney and averted a fatal outcome. The renal function recovered to the baseline with creatinine ranging between 1.3 and 1.5. The patient did not require dialysis at any point after ureteral stent placement and reconstructive surgery. In addition, the case highlights the importance of multidisciplinary management involving transplant nephrology, oncology, transplant surgery, and urology in such a complicated disease process.

Background: Hepatitis C affects racial minorities disproportionately and is greatest among the black population. The incidence of hepatocellular carcinoma has increased with the largest increase observed in black and Hispanic populations, but limited data remain on whether hepatitis C hepatocellular carcinoma in racial-ethnic minorities have the same utilization of services compared with the white population. Methods: We used the database of the National Inpatient Sample to identify hepatitis C-hepatocellular carcinoma patients (N = 200,163) who underwent liver transplantation (n = 11,491), liver resection (n = 4,896), or ablation of liver lesions (n = 6,933) from 2005 to 2015. We estimated utilization over time and assessed differences in utilization and inpatient mortality across patient characteristics. Results: In multivariate analysis, factors associated with utilization of services included treatment year, sex, race, insurance status, hospital type, and comorbidity burden, with black and Hispanic patients having statistically significantly decreased utilization. Factors associated with inpatient mortality included treatment year, sex, race, insurance status, hospital type, hospital region, and comorbidity burden, with black patients having a statistically significantly greater risk of inpatient mortality. Conclusion: We identified racial and socioeconomic factors which were associated with utilization of services and inpatient mortality for patients with hepatitis C hepatocellular carcinoma. Blacks were especially disadvantaged in the receipt of care. Further work to abrogate these findings is imperative to ensure equitable provision of surgical therapies. (C) 2020 Elsevier Inc. All rights reserved.

Human immunodeficiency virus (HIV) patients are living longer due to the availability of antiretroviral therapies, and non-AIDS-defining cancers are becoming more prevalent in this patient population. A paucity of data remains on post-operative outcomes following resection of non-AIDS-defining cancers in the HIV population.

Renal transplantation is the current standard treatment for end-stage renal disease and is associated with immunologic, vascular, and urologic complications. In this study we report urologic complications following ureteral reimplantation based on 1 urologist's experience at a single high-volume renal transplant institution. Methods. A retrospective review was performed on all patients who underwent ureteral reimplantation by the transplant urologist at the time of their kidney transplant between July 1, 1993, and December 31, 2016. Results. There was a total of 3951 ureteral reimplantations performed for 3890 renal transplants. The overall complication rate was 7% (276 patients). Vesicoureteral reflux was the most common complication (4.25%), followed by ureteral stricture (1.9%), urine leak (0.6%), and de novo ureteropelvic junction obstruction (0.25%). Conclusion. This study is a continuation of our previous case series. Over time, our overall rate of urologic complications has increased. Vesicoureteral reflux has remained the most common complication with increasing incidence compared with our prior reviews. One possible cause for increased incidence is our thorough longitudinal follow-up over more than 2 decades. Some patients who previously had no evidence of reflux eventually did in fact develop reflux. The incidence of ureteral stricture, urine leak, and ureteropelvic junction obstruction has overall remained stable over the past 23 years. In our program, 1 transplant urologist has performed almost all ureteroneocystostomies, leading to consistent management and generalizable results. Review of the literature shows variable rates of complications among different studies with multiple surgeons, disparate techniques, and short follow-up. Our study eliminates many of these confounding factors and provides more reliable, reproducible data.

Renal transplantation in a patient with aortoiliac prosthetic graft is a unique challenge. It requires that the renal artery is anastomosed directly to the vascular prosthetic graft. Nearly 0.2%-1.7% of the patients with aortoiliac prosthesis require renal transplantation in their life time. Outcomes following such procedure are controversial and anecdotal. In this report we present a unique case in which the renal artery was anastomosed to vascular prosthetic graft with a pertinent review of the literature.

Purpose: To analyze the impact of ESCAPE pathogens on post-operative infectious complications in a large contemporary renal transplant (RT) population. Methods: 1,012 RT recipients (2008-2012) from a single, large transplant center formed the study population. Demographic and clinical data was abstracted. Standard statistical methods were employed. Results: Post-operative infections were seen in 16.4% of RT patients (166/1,012). Resistant ESCAPE pathogens were seen in 5.4% (11) in 2008, 1.8% (4) in 2009, 4.8% (9) in 2010, 3.6% (7) in 2011 and 4.2% (9) in 2012 (p=0.31). UTI (7.2%) and surgical site infection (3.9%) were the most common infection sites followed by blood stream infection (1.5%). RT patients with early post-operative infection were 5 years older than those without infection, p=0.003. No significant gender differences was observed (p=0.112). African Americans (21.2%), deceased donor recipients (21%), those receiving thymoglobulin induction (18.5%), those with delayed graft function (16.8%), diabetes (19.3%) and leukopenia (18.6%) had higher infection rates (p<0.05 in each case). Patients with infection had shorter mean antibiotic administration to incision time (19 versus 22 minutes), p=0.041, but longer hospital stay (8 versus 5 days), p<0.001.Table: No Caption available.Conclusions: ESCAPE organisms accounted for only 3 -5% of the organisms isolated from post-operative infections in a modern large single-center RT population. African Americans, deceased donor recipients, thymoglobulin, diabetes and leukopenia were associated with increased rate of post-operative infection, and highlight a group of patients in whom rigid attention to aseptic technique, hemostasis and infection control practices maybe impactful and worthy of additional study.

With over 80,000 patients in the United States awaiting kidney transplantation, renal transplant surgery continues to evolve with attractive surgical options for living donation, which include laparoscopic donor nephrectomy (LDN) and robotic-assisted laparoscopic donor nephrectomy (RALDN). LDN is currently accepted as the gold standard procedure for living donor nephrectomy; RALDN is an evolving technique and may emerge as a preferred procedure over time. We present our initial experience with RALDN from December 2007 to August 2008. Thirty-five patients who underwent RALND were retrospectively analyzed and compared with 35 age- and time (year)-matched patients who underwent LDN. The parameters analyzed were length of hospital stay (3.2 ± 0.9 days, P < 0.59), estimated blood loss (146 ± 363 ml, P < 0.36), operating time (149 ± 44 min, P < 0.23), cold ischemic time (135 ± 202 min, P < 0.19), preoperative creatinine (0.82 ± 0.26 mg/dl, P < 0.46) and postoperative creatinine (1.44 ± 1.03 mg/dl, P < 0.20). There was no statistical difference between RALDN patients with single renal artery (n = 27) and those with more than one renal artery (n = 8) kidneys. There was one serious complication requiring conversion to open laparotomy to control a bleeding renal artery stump following extraction of the kidney. One-year graft survival for the 35 recipients of RALDN was 97.1%. RALDN is feasible and compares favorably to the standard LDN procedure with good graft survival. Robotic-assisted transplant surgery is an emerging technique with potential benefits to both surgeon and patient.

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.

Highly sensitized patients receive fewer kidney transplants and have a high risk for severe rejection with increased rates of graft loss. We present a highly sensitized child who after desensitization protocol received a kidney transplant and developed refractory acute antibody-mediated rejection. He failed to respond to standard therapy and needed an urgent splenectomy as rescue therapy. Our patient, an 18-yr-old AA male with ESRD due to obstructive uropathy received a second DD transplant. The allograft functioned immediately with SCr 1.4 mg/dL on day #5. On day #8, he was re-admitted with fever, oligoanuria, and renal failure. He was started on methylprednisolone pulse, thymoglobulin, intravenous immunoglobulin, and PP. The transplant kidney biopsy revealed features suggestive of acute AMR. On day #14, the patient remained dialysis dependent with no response to therapy. He underwent an urgent splenectomy and a slow increase in urine output and GFR was noted. The SCr one month post-splenectomy was 1.1 mg/dL. At one yr post-txp, his GFR remained stable with SCr 0.9 mg/dL on tacrolimus, mycophenolate mofetil, and prednisone. Urgent splenectomy successfully reversed refractory acute AMR, in our highly sensitized patient with second renal transplant.

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery1 Apr 20112196 MINIMALLY INVASIVE, ROBOTIC ASSISTED RENAL TRANSPLANTATION – DEVELOPMENT AND RESULTS OF A NEW SURGICAL TECHNIQUE Joseph V. DiTrolio, MD Stuart Geffner, MD Harry Sun, MD Francis Weng, MD Erin Vermeulen, PA Shamkant Mulgaonkar, andMD Michael D. LaSalleMD Joseph V. DiTrolioJoseph V. DiTrolio Roseland, NJ More articles by this author , Stuart GeffnerStuart Geffner Livingston, NJ More articles by this author , Harry SunHarry Sun Livingston, NJ More articles by this author , Francis WengFrancis Weng Livingston, NJ More articles by this author , Erin VermeulenErin Vermeulen Livingston, NJ More articles by this author , Shamkant MulgaonkarShamkant Mulgaonkar Livingston, NJ More articles by this author , and Michael D. LaSalleMichael D. LaSalle Florham Park, NJ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2435AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic assisted surgery has made major inroads in urology. We report the development and initial results of a new, completely minimally invasive technique for performing renal transplantation utilizing robotic assistance. METHODS Using the da Vinci S robotic Surgical System with dry lab, and animal lab experience prior to this study, competence in the technique was attained. All renal allografts were procured from living donors with standard laparoscopic techniques. Four laparoscopic/robotic ports were placed in the right lower quadrant, left lower quadrant, and peri-umbilical region. The allograft was introduced into the right lower quadrant via a 6 cm. incision in the right lower quadrant. All suturing of the single renal artery and renal vein were performed robotically. Ureterocystomy was performed either robotically or through the right lower quadrant incision. Laparoscopic ports and the right lower quadrant incision were closed in the standard multiple layer format. RESULTS 15 completely minimally invasive cases were successfully performed between 12/08 and 6/10 at St. Barnabas Medical Center with all patients having immediate graft function. Surgical times were increased on average from 2 hours to 2 ½ - 3 hours, which has been decreasing as proficiency improves. Major improvement was in the reduction of wound size, requiring a smaller surgical closure with no infection or complication in all the reported cases. This is the major risk factor in the immuno-suppressed patient. CONCLUSIONS Robotic assisted minimally invasive renal transplantation is technically feasible, and can be performed with excellent immediate outcomes. The absence of wound dehiscence or infection is a dramatic improvement in the post-operative care of these patients and continued proficiency is reducing surgical time. Further evaluation is warranted. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e881 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph V. DiTrolio Roseland, NJ More articles by this author Stuart Geffner Livingston, NJ More articles by this author Harry Sun Livingston, NJ More articles by this author Francis Weng Livingston, NJ More articles by this author Erin Vermeulen Livingston, NJ More articles by this author Shamkant Mulgaonkar Livingston, NJ More articles by this author Michael D. LaSalle Florham Park, NJ More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Background Since the initial description of laparoscopic donor nephrectomy (LDN) in 1995, the field of renal transplantation has continued to evolve. Although the identification of donor kidneys with multiple renal arteries (MRA) was considered a contraindication to LDN, improvement in the surgical technique to surmount the technical challenges of LDN with MRA have been established as the skill and laparoscopic experience of transplant surgeons evolves with time. Consensus regarding LDN with MRA and recipient outcomes is not uniformly documented amongst the transplant community. Methods A retrospective analysis of 976 patients who underwent LDN at our institution from January 1999 to August 2009 was performed. Patients were grouped based on the number of arteries and the data were compared with respect to patient demographics, operative characteristics, postoperative course and complications. Results The two donor groups had comparable outcomes except for operative time, which was significantly prolonged in patients with MRA kidneys when compared to a single renal artery (SRA) kidney ( P < 0.01). 1-, 3-year and estimated overall graft survival for the MRA recipient kidneys was significantly inferior when compared to SRA recipient kidneys. Conclusions Our decade long experience with LDN demonstrates that operative times for MRA kidneys are longer than for SRA kidneys, however complication rates are similar. Laparoscopic donor nephrectomy with MRA is a safe and effective procedure for living kidney donation; however, the recipient graft outcomes with MRA kidneys warrant appropriate preoperative counseling of recipients.

Abstract: Laparoscopic donor nephrectomy (LDN) is rapidly becoming the preferred technique for the procurement of living donor kidneys. An association of this technique with delayed graft function and higher risk for rejection has been reported in pediatric recipients. We reviewed our experience of 17 pediatric patients who received a living donor kidney, from 2002 to 2004, procured by LDN, and compared it with a matched group that received living donor kidneys harvested by the open technique. Patient demographics, etiology of renal failure, intra‐operative events, length of stay, serum creatinine decline, and graft function were reviewed. Our experience confirmed the findings of earlier reports specifically in small pediatric recipients. The LDN group showed a significantly slower decline in creatinine in the immediate post‐operative period and longer intra‐operative time. However, there was no difference between the two groups in the length of hospital stay, and creatinine clearances at discharge, six, 12 and 24 months post‐operatively. The incidence of acute rejection was similar in both groups. LDN is a safe procurement modality for pediatric patients. The risk for prolonged OR time and delay graft function has to be considered during the evaluation process.