Transluminal ureteral dilation was performed in 11 renal allograft recipients with transplant ureteral obstruction. Success was achieved in 5 patients (45 per cent) with a followup of 12 to 29 months (mean 19.6 months). All failures have been evident within 12 months of dilation. We conclude that ureteral dilation can provide long-term success in renal allograft recipients. However, continued close long-term monitoring of the anatomical and functional result is mandatory for patients treated in this manner.

Dilatation↗

PubMed1988

Outpatient angiographic evaluation of living renal donors.

A total of 71 potential living kidney donors was evaluated on an outpatient basis with either a modification of standard catheter angiography (30 patients) or intra-arterial digital subtraction angiography (41 patients). Both procedures provided accurate assessment of the main renal vasculature as proved at the time of donor nephrectomy. Neither technique was associated with any significant morbidity. We conclude that complete angiographic evaluation of potential kidney donors can be performed accurately and safely on an outpatient basis.

Angiography↗

PubMed1988

Nephrotic range proteinuria with "minimal change glomerulopathy" in human renal allografts: report of four cases.

Four patients who received renal allografts developed nephrotic range proteinuria 2 to 16 months after renal transplantation. Twenty-four-hour urine protein excretion at the time of renal allograft biopsy ranged from 5.9 to 17.0 g/24 hours. The serum creatinine at the time of renal allograft biopsy ranged from 2.0 to 3.9 mg/dl (180 to 350 mumol/L). Biopsies of the allografts demonstrated minimal glomerular abnormalities by light microscopy, immunomicroscopy, and electron microscopy. Two biopsies exhibited severe interstitial fibrosis. These four cases illustrate the unusual finding of "minimal change glomerulopathy" in renal allograft recipients exhibiting nephrotic range proteinuria. All four patients progressed to dialysis 4, 36, 46, and 53 months after transplantation. Transplant nephrectomy was performed in three patients. One showed acute cortical necrosis. Two showed glomerular, vascular, and tubular-interstitial features of chronic rejection.

Adult↗

PubMed1988

The use of single pediatric cadaver kidneys for transplantation.

We have reviewed our experience with 126 single pediatric cadaver kidneys (donor ages 9 months to 16 years) transplanted over a 10-year period. There were 17 donors aged 0-2 years, 55 donors aged 0-6 years, 34 donors aged 7-12 years, and 37 donors aged 13-16 years. One-year patient and graft survival was 88.2%/76.5%, 91%/74%,88.3%/69.1%, and 94.4%/80.6% for the respective groups. One-year patient and graft survival for an adult donor control group was 93%/69%. The percentage of recipients requiring dialysis in the early posttransplant period was 70.6%, 54.5%, 52.9%, 51.4%, and 52.4% for all groups, respectively. The time to reach a nadir creatinine was similar in all groups (24-30 days). While the functional outcome was comparable to cadaver transplantation utilizing adult donor kidneys, a higher incidence of infections and technical complications were encountered in the young-donor-age groups. Overall, there were 12 ureteral complications (8 fistulas, 4 stenoses), 3 bladder fistulas, and 4 renal artery stenoses. The urologic complication rate in kidneys from donors 0-2 years of age was 23.5% (all ureteral fistulas) versus 5% in the kidneys from adult donors. Only one graft was lost due to a technical complication. We conclude that, while cadaver kidneys from donors in the young age groups may be utilized successfully for transplantation, a higher incidence of urologic complications may be associated with their use. Careful harvesting and intraoperative techniques may minimize complications when utilizing kidneys from these donors.

Adolescent↗

PubMed1988