William T. Stubenbord

Donor treatment with phentolamine mesylate improves machine preservation dynamics and early renal allograft function

BACKGROUND It has been suggested that pharmacologic conditioning of the donor before organ procurement may protect the renal allograft from injuries associated with the cold ischemic period. We compared the administration of two vasoactive agents before organ procurement to: (1) determine their influence on machine perfusion characteristics and (2) determine their impact on delayed graft function (DGF) in transplanted renal allografts. METHODS Between January 1997 and December 1998, 150 kidneys were procured from heart-beating donors and preserved in our laboratory by machine perfusion (MP) or cold storage (CS). The following vasoactive agents were randomly administered to the donor 5 min before aortic cross clamp: phentolamine mesylate (PM) or hydralazine (H). The control groups received no donor conditioning. Kidneys were grouped as follows: (1) MP+PM, (2) MP+H, (3) MP, (4) CS+PM, (5) CS+H, (6) CS. 10 mg PM/50 kg donor weight was administered to the PM groups and 20 mg H/50 kg donor weight was administered to the H groups. DGF was defined as the need for dialysis within the first 7 days after the transplant. RESULTS MP+PM increased renal flow by 12% and decreased renal resistance by 18% compared with the MP+H group, and increased renal flow by 23% and decreased renal resistance by 30% compared with the MP group. Moreover, the MP+PM group was associated with improved early allograft function. CONCLUSIONS Donor treatment with PM immediately before aortic cross-clamp is associated with improved machine perfusion dynamics (renal flow and renal resistance) and lower incidence of DGF compared with donor treatment with H or no treatment. Moreover, MP of renal allografts was associated with improved early function compared with CS grafts.

Transplantation in Children with End Stage Renal Disease of Urologic Origin

AbstractUrologic disease is an important cause of end stage renal failure in children. Our experience with more than 700 renal transplants includes 30 children with renal failure of urologic origin who have received 34 renal homografts. The nature and natural history of the primary disease, corrective operations before transplantation, transplantation technique, complications and over-all success rate of these cases are reviewed.Vesicoureteral reflux and posterior urethral valves were the most common causes of end stage renal disease. The average time between diagnosis of a urologic problem and transplantation was 8.1 years. The incidence of renal dysplasia was high. It appears that many patients had limited potential for long-term urologic rehabilitation when they were evaluated initially.A wide variety of genitourinary tract operative procedures were done on 28 patients before transplantation (average 3.3 operations per patient). Cutaneous ureterostomy was the most frequent procedure, often following un...

Urinary infection in kidney transplantation

Urinary tract infection is the most frequent complication following renal transplantation and is important in the etiology of post-transplantation sepsis. The 87 renal homografts done in 1974 at The New York Hospital-Cornell Medical Center were reviewed retrospectively, with at least one year follow-up, in all cases, with particular attention to factors relating urinary tract infection to ultimate success or failure of the renal graft. The over-all incidence of urinary tract infection was 61%. Early infection was associated with a particularly poor prognosis for graft survival. Most patients with urinary infections after successful transplantation experience a combination of both early and late infections. Anatomic factors constitute a remediable cause of urinary infections after transplantation and should be searched for in cases of multiple, recurrent infections, de novo hypertension, or deterioration of previously stable graft function. There were significant differences in the bacteriologic spectrum of urinary tract infections associated with successful transplants as opposed to unsuccessful transplants.

Bilateral nephrectomy in chronic hemodialysis and renal transplant patients

Summary The records of sixty-one patients undergoing bilateral nephrectomy in conjunction with our chronic hemodialysis and renal transplant services were reviewed. Patients on chronic hemodialysis and with functioning homografts were compared with respect to morbidity, hospital stay, incidental operations, effect on blood pressure and hematocrit levels, and indications for surgery.

Irreversible renal failure following right nephrectomy and left renal vein ligation.

Ligation of the left renal vein has been advocated in certain clinical situations and venous outflow then is dependent on an adequate collateral venous system. We report on a child who suffered complete renal failure after ligation of the left renal vein in association with right nephrectomy and, subsequently, died. The left renal vein should be repaired in the presence of a solitary left kidney to prevent renal vein thrombosis and subsequent renal failure. This is particularly true in children in whom venous collateral circulation of the left kidney may not be well developed.

Renal transplantation between HL-A identical siblings with partial nephrectomy and machine preservation for ossified renal cell carcinoma

A case of renal transplantation between HL-A identical siblings is reported in which the donor kidney was found to have a calcified mass in the upper pole. Because an immediate pathologic diagnosis could not be made at the time of nephrectomy, the kidney was preserved with pulsatile perfusion for fifty-four hours after excision of the upper pole. At that time the diagnosis was still not available, and transplantation was performed only to have the report of ossified renal cell carcinoma established the following day.