Marie Dion

Donation after Cardiac Death Pediatric En Bloc Renal Transplantation

PURPOSE Use of small pediatric kidneys obtained from extremely young donors after cardiac death has been limited. This potential organ source remains under used by transplant teams. MATERIALS AND METHODS We reviewed all renal transplants at our institution from 2000 to 2013 to identify recipients of an en bloc pair of kidneys from deceased pediatric donors younger than 4 years. The outcomes of donation after cardiac death en bloc allografts were compared with neurological determination of death en bloc allografts. RESULTS A total of 21 recipients of en bloc renal allografts were identified, of which 4 organ pairs were obtained through donation after cardiac death. Mean ± SD donor age was 20.6 ± 11.6 months and weight was 12.4 ± 3.7 kg. Delayed allograft function occurred in 2 of 4 recipients of allografts obtained from donation after cardiac death en bloc and 3 of 17 recipients of allografts from neurological determination of death en bloc. One year after transplantation mean ± SD glomerular filtration rates were similar, at 80.7 ± 15.3 and 85.7 ± 33.4 ml/minute/1.73 m(2) in the cardiac and neurological allograft groups, respectively (difference not significant). Surgical complications occurred in 3 patients, and no allograft was lost to thrombosis. CONCLUSIONS We report successful transplantation of a small cohort of pediatric en bloc kidneys obtained through donation after cardiac death from donors younger than 4 years. Outcomes at 1 year are comparable to those in neurological determination of death en bloc allograft recipients.

Debilitating lower urinary tract symptoms in the post-renal transplant population can be predicted pretransplantation.

Background Overactive bladder and benign prostatic hyperplasia commonly cause lower urinary tract symptoms (LUTS) in the renal transplant (RTx) population. These LUTS may be masked by low urine output and may pose risk to renal allografts after RTx. Our purpose was to determine the frequency and severity of LUTS in RTx patients and to determine if patients at highest risk for LUTS could be predicted by validated questionnaires or other pre-RTx characteristics. Methods All patients who underwent RTx between 2005 and 2010 were asked to complete the validated Overactive Bladder Questionnaire based on patient symptoms before RTx and at 6 and 12 months after RTx. Male patients also completed the International Prostate Symptom Score survey. Patient, donor, and RTx characteristics and outcome data were collected. Results Of 466 RTx recipients, 23.8% responded and 89 patients were eligible for participation in the study. LUTS were common both before and after RTx as measured by the Overactive Bladder Questionnaire and International Prostate Symptom Score. Pre-RTx survey scores were predictive of moderate to severe post-RTx LUTS (relative risk, 4.1–18.0; P⩽0.05). Low urine output of less than 250 mL per day was also predictive of moderate to severe post-RTx LUTS (relative risk, 2.9–5.9; P<0.02). Conclusions Validated questionnaires and low urine output before transplantation may be used to identify patients at highest risk for LUTS after RTx. Identification of at risk patients would allow earlier initiation of treatment strategies to improve patient quality of life.

Natural History of Residual Fragments After Percutaneous Nephrolithotomy: Evaluation of Factors Related to Clinical Events and Intervention

OBJECTIVE To determine the natural history of residual fragments (RF) after percutaneous nephrolithotomy in long-term patient follow-up and to identify possible predictive factors for future intervention. MATERIALS AND METHODS We assessed all patients from 2006 to 2013 with postoperative computed tomography scan revealing RF, who did not undergo second-look nephroscopy or immediate ancillary procedures, and with at least 12 months of clinical follow-up. We evaluated factors associated with clinical, radiological, and surgical outcomes. Kaplan-Meier curves were used to calculate the proportion of asymptomatic and treatment-free patients during follow-up. RESULTS From 781 percutaneous nephrolithotomies performed, 202 patients underwent postoperative computed tomography scan and 44 patients with residual stones were included in the analysis. Mean follow-up was 57.9 months. A total of 24 patients (54.5%) developed at least 1 clinical outcome, and 32 (72.7%) patients had a surgical intervention. Only 4 patients had radiological evidence of stone passage. Multivariate analysis found that RF >4 mm and struvite or apatite stones were significant predictors for surgical intervention. The 5-year estimated probability to remain intervention free was 29%. CONCLUSION Despite the size of the RF, the vast majority of patients required an intervention during long-term follow-up. We identified that RFs of diameter >4 mm associate with the need for a surgical therapy, but the rate of clinical events was not affected by the size or location of the stones. Struvite or apatite composition stones had an increased risk of intervention during follow-up. Spontaneous passage was an uncommon event in this cohort.

Hypothermic machine perfusion improves Doppler ultrasonography resistive indices and long-term allograft function after renal transplantation: a single-centre analysis

To evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys can improve long‐term renal allograft function compared with static cold storage (CS).

CUA guideline on the evaluation and medical management of the kidney stone patient ‒ 2016 update

Despite technological advances in the surgical management of upper tract urinary stone disease that have significantly reduced patient morbidity and recovery time, new stone formation and recurrence remain significant health issues. Data from the U.S. National Health and Nutrition Examination Survey (NHANES) published in 2012 noted a kidney stone prevalence of 10.6% in men and 7.1% among women.1 Comparing these results to a similar survey conducted between 1976 and 1994, the overall prevalence of stone disease in the U.S. population has increased from 5.2 to 8.2%.2 An increase in stone formation, particularly among women, has also been observed such that the male:female ratio appears to be decreasing.3,4 Recent evidence also suggests there may be an increase in the incidence of certain stone compositions, such as uric acid, a type of stone clearly linked to both dietary and metabolic risk factors.5 Recurrence rates after an initial symptomatic stone event are reported to be from 30‒50% within 10 years of first presentation.6,7 Patients are, therefore, generally motivated to explore prevention strategies.1 Studies have shown, however, that patients are more willing to undergo metabolic evaluation compared to physicians’ willingness to further investigate them.8 Epidemiological data from the U.S. show that only 7% of patients with a high risk of recurrent stone disease undergo metabolic evaluation by any physician.9 The odds of undergoing metabolic evaluation were 2.9 and 3.9 times higher if patients were seen by a nephrologist or urologist, respectively. Bensaleh et al noted that 81% of patients interviewed would prefer to take a prophylactic medication than undergo another stone episode, and 92% of respondents preferred medication to undergoing surgery.8 In summary, the vast majority of stone patients would benefit from metabolic evaluation, but are not being investigated. The economic burden of recurrent stone disease is also significant. Estimates of direct costs to care for and treat patients with stones and the indirect costs related to lost work time exceed

Cost analysis of two follow-up strategies for localized kidney cancer: a Canadian cohort comparison.

5 billion USD.10,11 The observed increases in healthcare expenditures associated with nephrolithiasis are likely due to the increasing prevalence12 and procedure-related costs, despite a shift towards outpatient treatment, shorter length of hospital stay, and more minimally invasive procedures.11 Given the rising rates of obesity and diabetes and their association with stone formation, the cost of managing stone disease is expected to increase to 1.24 billion dollars yearly in the U.S. by 2030.13 Clearly, the need for stone prevention in those at risk will continue to have an important role. In 2010, the Canadian Urological Association (CUA) Guidelines Committee commissioned the development of a clinical practice guideline on the evaluation and medical management of patients with upper tract urolithiasis. The aims of the guideline were to help clinicians identify patients at heightened risk of stone recurrence, to outline the required investigations to assess these patients, and to provide up-to-date advice on dietary and medical interventions of proven benefit in the Canadian context. In accordance with the CUA’s policy of reviewing the content of guidelines every five years, this topic was felt to be ready for revision to reflect new advances in the preventative management of patients with renal stones. It should be noted that this guideline addresses the evaluation and medical prophylaxis of upper tract stones and not stones forming within the bladder.

KIM-1 Is a Potential Urinary Biomarker of Obstruction: Results from a Prospective Cohort Study.

INTRODUCTION The cost of surveillance strategies in patients after radical nephrectomy for localized primary renal cell carcinoma (RCC) has not been evaluated. We compared the costs of 2 different surveillance strategies, the new Canadian Urological Association (CUA) guidelines and the old strategy implemented in our institution. METHODS Seventy-five patients who underwent radical nephrectomy for primary non-metastatic renal cancer were retrospectively reviewed. The direct cost of surveillance was determined and compared with the theoretical cost which would have been accrued using the CUA guidelines. RESULTS Our mean follow-up was 31.1 (SD ± 20.4) months. The overall and disease-free survival endpoints were 87.7% and 85.2%, respectively. Total medical costs were higher for our old institutional surveillance strategy than the CUA guidelines (

Transplantation of pediatric renal allografts from donors less than 10 kg

181 861 vs.

MP51-17 IMPACT OF PERCUTANEOUS NEPHROLITHOTRIPSY ON EARLY AND LONG-TERM RENAL FUNCTION IN PATIENTS WITH A SOLITARY KIDNEY

135 054). For the complete follow-up of 75 patients, a cost-savings of

Assessing the Magnitude of Effect of Bone Structures on Shockwave Lithotripsy Fragmentation: Results from an In Vitro Study

46 806 could have been achieved following the CUA guidelines (p = 0.002). Of recurrences, 7 of 8 were detected by routine screening, only 1 recurrence was identified by symptoms. The cost per recurrence detected in our old protocol was