P. Mohan

Successful renal transplantation in children with spina bifida: Long term single center experience

Abstract:  We report long‐term follow up data on cadaveric renal transplantation for end stage renal failure (ESRF) in spina bifida children. Between February 1989 and July 2001, 12 cadaveric renal transplants were performed in 10 children, eight females and two males. Mean age at transplantation was 13.4 yr (range 9–16). Of the patients, eight were wheelchair bound and two were independently mobile. Before transplantation surgical management of the urological tract included, enterocystoplasty and clean intermittent‐self catheterization in five patients and ileal conduit urinary diversion in one. A total of eight patients were on renal replacement therapy before receiving the graft while two underwent pre‐emptive transplantation. The 1‐ and 5‐yr graft survival rates were 81 and 81%, respectively. Four grafts failed – two patients have successfully undergone subsequent transplantation. Causes of graft failure were chronic rejection in two, acute rejection and vascular thrombosis in one and vascular thrombosis in one patient, respectively. Two patients died after graft nephrectomy. At a median follow‐up of 4.08 yr (range 1 day to 10.65 yr), eight of the 12 grafts are functioning with median serum creatinine of 123 mmol/L (range 65–169). These data demonstrate the feasibility of cadaveric renal transplantation in patients with spina bifida and ESRF. We currently recommend that patients with spina bifida should not be deprived of the benefits of renal transplantation.

Rabbit antithymocyte globulin related decrease in platelet count reduced risk of pediatric renal transplant graft thrombosis

Abstract:  Graft thrombosis is a serious complication in pediatric renal transplantation. We assess a potential protective effect for the decrease in platelet count associated with RATG therapy against pediatric renal transplant graft vascular thrombosis. Between January 1986 and December 1998, 120 kidney transplants were performed in 95 pediatric recipients. Patients were divided into two groups. Group 1 (n = 61), non‐RATG group received cyclosporine, azathioprine and steroids, while group 2 (n = 59), RATG group, received in addition, RATG at day 1 and continued for 4–10 days postoperatively. Platelet count prior to transplant, median change in absolute platelet count at 1 and 3 days post‐transplant was recorded. Graft thrombosis incidence was examined. Six grafts (5%) developed thrombosis. All were in group 1 (p = 0.028). Median pretransplant platelet count (×109/L) in group 1 was 283 vs. 280 in group 2 (p = 0.921). Median decrease in absolute platelet count (×109/L) from pretransplant levels at one and three days post‐transplant for group 1 and 2 was 18 vs. 83 (p ≤ 0.001) and 39 vs. 105 (p ≤ 0.001), respectively. Graft thrombosis risk factors were similar in both groups. RATG use was statistically significant (p = 0.044) for reduced risk of graft thrombosis in multivariate analysis. Patients receiving RATG showed significant decrease in both platelet count and graft thrombosis incidence. A role for RATG related effect on platelet count is assumed.

A review of inpatient urology consultations in an Irish tertiary referral centre

INTRODUCTION Our institution is a 680-bed tertiary referral centre with broad medical and surgical subspecialty services. We retrospectively audited the pattern of inpatient consultations from all specialities within our institution to the urology department over a 1-year period. METHODS All consultations to the urology service were identified from our computerised inpatient consultation system from July 2010 to June 2011. Follow up data on investigations, interventions and subsequent outpatient appointments were also identified by review of individual patient discharge letters. RESULTS Seven hundred and twenty five inpatient consultations were received over the period. The male to female ratio was 7:3. Mean age of patients was 66 (15-96) years. Seventy three percent of referrals were from medical sub-specialities, most commonly nephrology (17%), gastroenterology (11%) and respiratory medicine (9%). The remainder were from general surgery (16%) and other surgical sub specialities (11%). Interns (66%) and senior house officers (SHO) (28%) communicated the majority of consults. Male lower urinary tract/benign prostate related issues resulted in 25% of all consultations. Less than half of consults (47%) resulted in interventions initiated by urology, most commonly of which were catheter insertions (48%) and endoscopic procedures (35%). Only 43% of consultations were followed up in the outpatients setting. CONCLUSIONS Inpatient consultations constitute a significant workload for urology services. The majority of these referrals did not require any urological intervention and could have been seen routinely in the outpatient setting. Providing structured referral guidelines and achieving better communication with referring teams may help to optimise this service.

Incidence and long-term outcomes of squamous cell bladder cancer after deceased donor renal transplantation

To review the incidence and long‐term outcomes of squamous cell carcinoma (SCC) of the bladder in patients after kidney transplantation.

Outcome of deceased donor renal transplantation in patients with an ileal conduit

Renal transplantation in recipients with an ileal conduit is uncommon and occasionally controversial as it has been associated with high morbidity and mortality rates. We report on 17 patients with an ileal conduit who received a deceased donor renal transplant at our institution between January 1986 and December 2012. We retrospectively reviewed their allograft and surgical outcome. There were four mortalities at five, five, 39, and 66 months post‐transplant. Sixteen of 17 grafts functioned immediately; one patient had primary non‐function secondary to vascular thrombosis. Thirteen of 17 (76.5%) grafts were functioning at a mean follow‐up period of 105 months. The mean serum creatinine at follow‐up was 111 μM (±38.62). Five patients had seven episodes of urosepsis requiring hospital admission, and five patients received treatment for renal stone disease. We conclude that given improvements in immunosuppression, surgical technique, infection treatment, and selection criteria, we believe that renal transplantation in the patient with an ileal conduit yields excellent graft survival, although there is a high morbidity rate in this cohort of patients in the long term.

Successful long‐term outcome of kidney transplantation in a child with Kabuki syndrome

Abstract:  We report a case of successful renal transplantation in a child with Kabuki syndrome. We discuss the potential problems that might be encountered following kidney transplantation in children with Kabuki syndrome, and the management of these problems. We conclude that kidney transplantation is a feasible and appropriate treatment option for renal impairment in children with this syndrome.

Pancreas transplantation in Ireland

BACKGROUND We report on our experience of pancreatic transplants performed in Beaumont Hospital from 1992 to January 2003. During this period, 63 pancreatic transplants were carried out. Simultaneous pancreas and kidney transplantation is regarded as the treatment of choice for Type 1 diabetics with end stage renal failure (ESRF) by the American Diabetes Association. METHODS A retrospective review of all the pancreas transplants between 1992 and January 2003 was carried out. All of the patients had insulin-dependent diabetes mellitus (IDDM) and, in addition, 57 of the recipients had concomitant end stage renal failure. For two of the patients, this was a second transplant, one of them having had a previous renal graft which thrombosed. The second patient underwent a simultaneous pancreas and kidney (SPK) transplant in 1998 with loss of the pancreatic graft shortly afterwards. She subsequently received a pancreas only transplant in 2002. RESULTS The follow-up period ranges from one month to ten years and parameters used to assess graft function include Hb A1c and serum creatnine (SPK only). There have been 22 graft losses (six kidneys, nine pancreases and seven involving both the kidney and pancreas), to date. The one-year graft survival was 80.4% (pancreas) and 92.7% (kidney), with a one-year patient survival of 94.8%, which compares favourably with figures from other centres. At follow-up, the average Hb A1c at six months post-transplant was 5.7% with a serum creatnine of 121micmol/L being recorded at one month. CONCLUSION Our experience of pancreas transplants at Beaumont Hospital has been very encouraging with graft and patient survival equivalent to other international centres.

Increased mid‐abdominal circumference is a predictor for surgical wound complications in kidney transplant recipients: A prospective cohort study

Kidney transplant recipients are at an increased risk of developing surgical site wound complications due to their immunosuppressed status. We aimed to determine whether increased mid‐abdominal circumference (MAC) is predictive for wound complications in transplant recipients. A prospective study was performed on all kidney transplant recipients from October 2014 to October 2015. “Controls” consisted of kidney transplant recipients without a surgical site wound complication and “cases” consisted of recipients that developed a wound complication. In total, 144 patients underwent kidney transplantation and 107 patients met inclusion criteria. Postoperative wound complications were documented in 28 (26%) patients. Patients that developed a wound complication had a significantly greater MAC, body mass index (BMI), and body weight upon renal transplantation (P<.001, P=.011, and P=.011, respectively). On single and multiple logistic regression analyses, MAC was a significant predictor for developing a surgical wound complication (P=.02). Delayed graft function and a history of preformed anti‐HLA antibodies were also predictive for surgical wound complications (P=.003 and P=.014, respectively). Increased MAC is a significant predictor for surgical wound complications in kidney transplant recipients. Integrating clinical methods for measuring visceral adiposity may be useful for stratifying kidney transplant recipients with an increased risk of a surgical wound complication.