Marco Decurtins

Secondary Pyeloureterostomy after Ureter Necrosis in Renal Transplant Recipients

After kidney transplantation, urological complications account for significant morbidity necessitating reoperation in a substantial number of patients. In cases with urinary tract necrosis after renal transplantation secondary pyeloureterostomy represents an accepted method for urinary tract reconstruction. In our institution 2% of all kidney grafts required secondary pyeloureterostomy. In all cases the recipients own ureter was investigated before reoperation by retrograde pyeloureterography. Pyeloureterostomy was performed with a standard technic, the recipients own kidney being removed in all but 5 patients. All 25 patients had normal kidney function immediately after secondary pyeloureterostomy. Urological complications occurred in 7 patients (anastomotic leakages in 4, stenosis in 3); 5 out of 7 complications were managed conservatively (nephrostomy, transureteral stenting). Two patients needed reexploration for reanastomosis. Our results confirm the simple and safe technic of pyeloureterostomy for urinary reconstruction in patients with ureter necrosis after renal transplantation.

Liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome

We report the case of a young woman with Budd-Chiari syndrome in whom mesentericoval shunt was first performed, followed by transcaval liver resection and hepatoatrial anatomosis 3 years later. Liver transplantation became necessary 5 years later because of deterioarating liver function with portal hypertension and bleeding. Successful transplantation was performed with atrioatrial anastomosis with help of cardiopulmonary bypass, simplifying considerably the technical procedure and reducing dramatically blood loss.

Latex agglutination test for cytomegalovirus antibody screening of transplant donors important aspects

In a retrospective study, false negative readings of CMV Scan results were detected. In a following prospective survey of 72 transplant donor sera, CMV Scan had a sensitivity and a negative predictive value of greater than 95%. Although CMV Scan is a rapid and useful test, a higher reliability can be achieved if results are controlled by another sensitive test or, at the least, CMV Scan is read by two different persons.

273. Verzögerte percutane gangverödung - erfolgreiche methode zur versorgung der exokrinen sekretion nach pankreastransplantation

SummaryRecurrent pancreatic fistulae with a high incidence of reoperations after intraoperative duct obliteration led to a new technique usingdelayed percutaneous duct occlusion, which is per formed approximately 6 weeks after transplantation through a silicon tube placed in the main pancreatic duct. With this method,improved graft survival and, above all, a markedreduction in pancreatic fistulae with70%fewer reoperations were observed.ZusammenfassungPersistierende Pankreasfisteln mit einer hohen Reoperationsrate nach intraoperativer Gangverödung veranlassten eine Modifikation dieser Technik. Bei derverzögerten percutanen Gangverödung über einen in den Pankreas-Hauptgang eingelegten Drain erfolgt die Prolamininjektion durchschnittlich sechs Wochen nach Transplantation. Mit dieser neuen Methode konnten nebst einerVerbesserung des Transplantatüberlebens, vor allem eine itAbnahme der Pankreasfisteln um mehrals die Hälfte beobachtet werden, was auch mit einer um70% geringeren Reoperationsrate einherging.