Jiri Fronek

Introducing hand-assisted retroperitoneoscopic live donor nephrectomy: learning curves and development based on 413 consecutive cases in four centers.

Background. Hand-assisted and retroperitoneoscopic techniques reduce the risk of bleeding and intraabdominal complications in living donor nephrectomy (LDN). This study reports on our four-center experience, development, and learning curves from the first 413 LDNs using a hand-assisted retroperitoneoscopic (HARS) technique. Methods. The first 413 consecutive donors operated on using HARS were included in the study. Donor demographics, perioperative and postoperative data, complications, and recipient outcomes have been compiled. The data were analyzed as a whole and separately for each center, looking at center differences and learning curves over time. Results. Significant differences were found in donor demographics between centers for the variables: age, body mass index, number of arteries, and side of operation. Mean operating time was 170.2 min, with significant differences between centers. Operating time was also significantly influenced by learning curves, sex/body mass index, and side of operation. Warm ischemia time differed significantly between centers and was influenced by center-wise learning and number of arteries. Overall conversion rate was 2.4% and differed significantly between centers. There was no mortality and no intraabdominal complications. Apart from the conversions and one pulmonary embolism, there were no major intraoperative or postoperative complications. Overall 3-month graft survival was 99%, with 96% immediate onset of function and 1% ureteral complications. Conclusions. The HARS technique reduces the risk of intraabdominal complications. It can be implemented with excellent donor and recipient outcomes despite different population demographics and center/surgeon-related tradition and experience. On the basis of our experience, we recommend the technique to increase the safety margin of LDN.

Successful excision of a suspected mycotic transplant renal artery patch aneurysm with renal allograft autotransplantation.

Aneurysm of the transplant renal artery has an incidence rate of less than 1% and is associated with graft loss and mortality (1). We report a case of a suspected mycotic transplant renal artery patch aneurysm developing in a patient with systemic infection and a functioning renal allograft treated with surgical excision, in situ reconstruction, and subsequent allograft auto transplantation with successful outcome.

A successful live donor kidney transplantation after large angiomyolipoma excision

INTRODUCTIONnAngiomyolipoma is the most common benign neoplasm of the kidney. Successful transplantation of an AML affected kidney has been reported. However it is still often seen as a contraindication to transplantation.nnnPRESENTATION OF CASEnA 47-year-old female underwent assessment for a direct specified kidney donation to her husband who had end stage renal failure, due to adult polycystic kidney disease. Routine pre-operative CT angiography demonstrated a large 6cm×4cm AML arising from the upper pole of the right kidney. Right-side hand assisted retro-peritoneoscopic live donor nephrectomy with bench tumour excision was subsequently performed. Recipient implantation was unremarkable with no haemorrhage.nnnDISCUSSIONnHistology confirmed a 7cm AML. At 36 months follow up, the recipients serum creatinine was 158μmol/l and eGFR 40ml/min without the need for dialysis at any stage.nnnCONCLUSIONnAML should not be a contraindication for specified live kidney donation, despite a size of 7cm.

Organ Transplantation in the Czech Republic

DEMOGRAPHICS OF THE CZECH REPUBLIC The Czech Republic is a member of the European Union, bordering Germany to the west, Austria to the south, Slovakia to the east, and Poland to the northeast. The country covers an area of 78 866 km with a population of 10.5 million; the capital city of Prague counts more than 1.2 million inhabitants. The Human Development Index as a statistical composite of life expectancy, education, and per capita income indicators ranks the Czech Republic as the 28th worldwide just after Spain and Italy. The healthcare system is based on a mandatory insurance model, with fee-for-service care funded by employmentbased insurance plans, insurance for children, seniors, and unemployed is covered by the state. The Euro Health Consumer Index, a quality assessment tool comparing European healthcare systems ranks the Czech Republic as 13th in Europe. The median life expectancy for both sexes is 78.8 years.