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G Polo Villar

Publications and source records attributed to G Polo Villar.

12 recordsLinked to original sources
PubMed2001

[Experience with cadaver renal transplant with ex situ reconstructed arteries].

OBJECTIVE: To review our experience with cadaveric kidney transplantation with ex situ reconstruction of damaged renal artery. METHODS: To obtain a minimum follow-up of 5 years, 20 cases treated from January 1989 to December 1994 were retrospectively reviewed. The control group comprised 73 patients that had received an "ideal" graft during the same period. Both groups were similar for all the variables that could influence graft outcome. RESULTS: Both groups showed similar results for incidence of NTA, rejection episodes, creatinine values, surgical complications or reoperations. However, a strong trend (25% of the cases) to develop renal artery stenosis was found (p = 0.052). These latter cases were diagnosed by the onset of arterial hypertension that was difficult to control and were treated conservatively by percutaneous angioplasty with good functional results in 100% of the cases, although 80% required more than one session. This complication, however, did not lead to graft failure. CONCLUSIONS: Renal grafts with arteries damaged during procurement or as a result of pathological changes, such as arteriorclerosis or aneurysm, are useful after bench reconstruction before transplantation. However, the greater trend to develop symptomatic arterial stenosis that has been observed makes it convenient to look for this complication routinely during follow-up. If diagnosed and treated early, it does not influence the graft outcome. The therapeutic approach is first by percutaneous transluminal angioplasty and if it fails, then by open surgery.

Adolescent↗
PubMed2000

[Cadaver kidney grafts from donors over 60 years of age should be considered as suboptimal].

Considering the scarcity of organs for transplantation, one possible solution is the use of grafts from aged donors (over 50 years). We have reviewed our experience in the case of kidney transplantation considering the period from 1989-1994 in order to attain a minimum follow-up of 36 months. We compare three groups: donors aged between 50-60 years (n = 32), donors aged over 60 years (n = 25) and a control group formed by donors of "ideal" ages. The results show that kidneys from donors over 60 years evidence, as compared to the control group, a higher incidence of acute tubular necrosis (p = 0.032), significantly higher blood creatinine levels in all the intervals considered, and a graft survival which is 14% less at 12 months and 40% less at 36 months (p = 0.0009). These differences are most probably to be attributed to the changes caused in these organs by advancing age and by previous pathological situations, as we have not detected a higher incidence of immunologic or surgical complications.

Age Factors↗
PubMed2000

[Experience with kidney transplantation with children as donors].

OBJECTIVE: To analyze the results achieved with transplantation of children kidneys to adult recipients. METHODS: The results achieved with transplantation of children cadaver kidneys (< 15 years) from 1989 to 1994 over a follow-up period of at least 36 months were reviewed. Patients (n = 43) were stratified into group A (13 grafts from donors < or = 6 years), group B (30 grafts from donors > 6 years) and group C (control group), which comprised 73 patients who received grafts from donors of an ideal age during the same time period. All three groups were similar for variables considered to influence the results of transplantation, except for the higher incidence of hypotension in group B. RESULTS: The number of episodes of rejection was three-fold higher in group A than in the control group (p = 0.019). A higher incidence of surgical complications, principally vascular complications (arterial thrombosis, renal rotation), was found in group A versus the control group (p = 0.039). When the grafts transplanted en bloc from donors under 12 months were excluded from the analysis, the incidence of vascular or urological surgical complications in group A was not found to be higher than that of the control group. No difference was found for mean length of stay, renal function (creatininemia), graft or patient survival for the three groups. CONCLUSIONS: Grafts from donors more than 6 years old showed a similar behavior as those from donors of an ideal age. Furthermore, single kidneys from donors aged more than 12 months can be transplanted with excellent results. It is necessary to have a larger series to confirm and explain the high incidence of acute rejection in grafts from donors less than 6 years old.

Adolescent↗
PubMed1996

[Renal transplantectomy].

OBJECTIVES: Renal transplantation is currently the treatment of choice for most of the cases with end-stage renal failure. However, approximately 35% present failure of graft function within 5 years post-transplantation. The need for graft removal, which is infrequently discussed in the literature, and the surgical technique employed are discussed. METHODS: From September, 1976 to December, 1994, we have performed 877 renal transplants; of these, 145 (16.5%) required removal. The literature is reviewed, with special reference to the indications for graft removal and the different surgical techniques employed. RESULTS: Our data show that 42% of non-functioning renal transplants required removal at some time. No complications arising from conservative management were observed in the remaining 58%. Graft failure due to acute or early acute rejection invariably necessitated removal; thereafter transplant nephrectomy was uncommon. There were no deaths from failed grafts maintained in situ in this series. CONCLUSIONS: Like other authors, our approach is to leave the graft in situ with or without low doses of corticosteroids. Transplant nephrectomy is reserved for the symptomatic cases. For cases requiring nephrectomy less than three months post-transplantation, we utilize the extracapsular approach; thereafter we utilize the subcapsular technique.

Blood Loss, Surgical↗
PubMedDate not supplied

[Impact of transplantectomy of the first graft on the clinical course of cadaver renal retransplantation].

PURPOSE: At the present time a number of prediction factors on the outcome of second cadaver renal transplants are known, in particular the influence of recipient response to the first graft. However, we do not know if retaining or removing the non-functioning organ has any repercussion on subsequent transplants. This is the object of the present study. MATERIAL AND METHODS: A retrospective study was carried out on the clinical records of 80 patients who had undergone a second cadaver renal transplant under CyA between 1985-1995 at Hospital 12 de Octubre. Data on the characteristics and outcome of the first and second transplants were collected, plus those concerning the recipient and donor. These variables were used to construct a multivariant analysis model of graft survival. The nephrectomy of the non-functioning graft was only carried out when absolutely necessary (n = 58). RESULTS: The multivariant analysis showed that the nephrectomy of the non functioning graft did not modify the risk of recipient sensitization or the probability of developing acute or chronic rejection of the second graft. However, it reduced the risk of losing this second graft at medium or long term significantly (p = 0.009). CONCLUSIONS: These data constitute the first solid argument in favor of elective nephrectomy in candidates for a second cadaver renal transplant. Nevertheless, a more thorough study should be carried out of the immunological mechanism involved before recommending this as a general procedure.

Adult↗
PubMedDate not supplied

[HLA compatibility and antigenic re-exposure. Impact on the clinical course of cadaver kidney transplantation].

OBJECTIVES: A number of prediction factors on the outcome of cadaver renal transplants have been recognized, particularly the influence of recipient response to the first graft. However, the influence of HLA compatibility and of repeated recipient and donor antigen mismatches remain a controversy. The importance of the foregoing on the survival of the second renal graft is analyzed in this study. METHODS: The clinical records of 80 patients who had undergone a second cadaver renal transplantation from 1985 to 1995 at the Hospital 12 de Octubre (Madrid, Spain) were reviewed. Data on the recipient, donor and graft characteristics and outcome of the first and second transplants were collected for multivariate analysis of graft survival using the Cox regression method. The importance of the overall HLA compatibility and of each HLA locus, and the effect of antigenic re-exposure on the survival of the second renal graft were analyzed. RESULTS: The multivariate analysis showed a significant increase of the survival of the second graft when there were at least three compatible antigens between donor and recipient (p = 0.02). Compatibility of the HLA-A and DR loci appeared to improve the outcome, although the differences were not statistically significant. However, a significant improvement in the survival of the second cadaver renal allograft was found for repeated HLA mismatches between the recipient and donors (p = 0.006). CONCLUSIONS: Our data corroborate the benefits of assigning renal grafts according to the degree of HLA compatibility also for the second renal transplant. Furthermore, our data show that re-exposure to previous mismatched antigens need not be hazardous for the second renal transplant in the cyclosporine era.

Adult↗
PubMedDate not supplied

[Percutaneous treatment of renal transplant complications].

The use of percutaneous endourological techniques in urological complications of renal transplantation has dropped the morbidity/mortality index. These techniques, especially percutaneous nephrostomy, allow us a renal drainage route, thereby improving the recipient's clinical situation and that of the transplant as well. Also, it will allow us access to other therapeutic means such as: introducing catheters, probes for dilating stenosis, and a means of approach to percutaneous nephrolithectomy. Perirenal collections (hematoma, lymphocele, abscess) can be resolved percutaneously to a large extent, without having to resort to surgery. It was observed from the 38 percutaneous endourological procedures performed that in many cases this was the definitive treatment, and in most cases allowed us to place the patient in an acceptable surgical condition. Therefore, we may conclude by stating that percutaneous endourological techniques have proven to be effective alternatives to immediate surgical reintervention, and that they should be used when faced with any urological complication of renal transplantation.

Adult↗
PubMedDate not supplied

[Reutilization of a transplanted kidney by a 2nd receptor].

Contribution of what we believe to be the first case of successful reutilization of the same renal graft by a second receptor after functioning for some time in other patient. Transplantectomy was performed 8 days after initial RT, subsequent to the recipient suffering a fatal AVC. The purpose of this paper is to underline the sequence and technical methodology of this procedure which may become a resource to be taken into account in similar cases.

Adult↗