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M P Mazzoni

Publications and source records attributed to M P Mazzoni.

16 recordsLinked to original sources
PubMed2006

Laparoscopic donor nephrectomy: short learning curve.

INTRODUCTION: The learning curve of laparoscopic donor nephrectomy (LDN) may represent a great technical challenge at centers with low volume of living donors. The number of LDNs required to overcome the learning curve is still unclear. Here we report the modality of approach to LDN at a low-volume living donor transplant center. MATERIALS AND METHODS: We reviewed the records of two groups of donors operated by two different surgeons between January 2002 and October 2005. We compared donor hospital stay, operative time, presence of multiple renal arteries, blood loss, operative details, and complications. RESULTS: The first six operations (group A) were performed by a well-trained laparoscopic surgeon (A.P.) with a consolidated experience in the LDN procedure, attended by our training surgeon (R.D.V.) who conducted the other six cases (group B). No conversion to an open procedure was necessary and there were no major minor complications. Mean operative time was 267.5 (+/-55.9) minutes in group A and 300 (+/-43.4) minutes in group B (P = .28). Mean warm ischemia time was 125 (+/-61.6) seconds in group A and 189.2 (+/-18.6) seconds in group B (P = .035). Mean hospital stay was 5.3 days in group A and 5.6 days in group B. CONCLUSIONS: LDN can be performed safely and efficiently in transplant centers with initial experience. A collaborative approach to this difficult procedure with a surgeon skilled in donor nephrectomy minimizes the risk to the donor and reduces the learning curve.

Female↗
PubMed2006

Octreotide in the treatment of lymphorrhea after renal transplantation: a preliminary experience.

BACKGROUND: Lymphorrhea is a minor complication after kidney transplantation but may develop into a lymphocele and prolong hospital stay. Treatment is conservative based on percutaneous drainage until lymphatic leakage cessation. It has been reported that octreotide has beneficial effects to treat lymphorrhea after axillary node dissection and excision of lymphatic malformations. The aim of this study was to report preliminary experience about octreotide treatment in lymphorrea after kidney transplantation. MATERIALS AND METHODS: This retrospective study included 20 recipients of cadaveric kidney allografts with posttransplant lymphorrhea including 10 treated with instillation of povidone iodate solution, and the other 10 with octreotide (0.1 mg three times a day subcutaneously). We reviewed the daily amount of fluid collection, duration of lymphorrhea, complications, lymphocele formation, rejection episodes, graft outcomes, and hospital stay. RESULTS: The average duration of lymphorrhea was 8.5 (+/-4.5) and 16.3 (+/-7.3) days for the octreotide versus the povidone groups, respectively (P = .001). No complications occurred among the octreotide group, while three lymphoceles grew among patients treated with povidone solution. No differences were observed for acute rejection episodes or renal function between the groups. No octreotide-related adverse events were noted. CONCLUSION: The mean length of lymphorrhea was lower with octreotide versus iodate povidone solution treatment. There was a shorter hospital stay and minor patient discomfort. In conclusion, lymphatic leakage after kidney transplantation may be successfully managed by octreotide administration.

Adult↗
PubMed2005

University of Wisconsin solution versus Celsior solution in clinical pancreas transplantation.

INTRODUCTION: This study compared the safety and efficacy of University of Wisconsin solution (UW) and Celsior solution (C) in pancreas transplantation (PTx). METHODS: A retrospective review of 154 PTx performed over a 61-month period included 77 grafts preserved with UW and 77 with C. The two groups were comparable for both donor and recipient characteristics. RESULTS: After a mean cold ischemia time of 624 minutes (range 360 to 945 minutes) for UW versus 672 minutes (range 415 to 1005 minutes) for C (P = NS), no primary endocrine nonfunction occurred. Delayed endocrine function was diagnosed in two grafts in the UW group (2.6%) versus none in the C group (P = NS). After a minimum follow-up of 4 months (mean 26.5 +/- 15.2 months), 22 recipients (UW = 11 vs C = 11; P = NS) required relaparotomy. Overall, 18 pancreata were lost due to either patient death with functioning graft (UW = 4 vs C = 1; P = NS) or graft loss due to other reasons (UW = 8 vs C = 5; P = NS). Actuarial 1- and 5-year patient survival rates were 93.5% and 86.8% for UW compared with 98.7% and 98.7% for C (P = .04). Actuarial graft survival rates at the same times were 88.3% and 75.0% for UW compared with 90.4% and 90.4% for C (P = NS). CONCLUSIONS: Within the range of cold ischemia times reported in this study, UW and C show similar safety and efficacy profiles for PTx.

Adenosine↗
PubMed2005

The role of cholecystectomy in renal transplantation.

INTRODUCTION: We reviewed our clinical experience to assess the role of cholecystectomy transplant candidates pre- and posttransplantation. METHODS: Between April 1986 and December 2003, 57 (6.8%) candidates among 839 kidney transplants were found during routine pretransplant screening to show gallstones. RESULTS: Thirty nine (68.4%) symptomatic patients underwent cholecystectomy before transplantation. Among 18 (31.6%) asymptomatic patients monitored after transplantation, the 7 (39%) who developed biliary tract symptoms underwent laparoscopy or minilaparocholecystectomy without postoperative morbidity, mortality, or graft loss. CONCLUSIONS: Symptomatic gallstones have to be treated using the laparoscopic cholecystectomy or minilaparotomy technique. In asymptomatic cholelithiasis prophylactic cholecystectomy is only reserved for patients with biliary "intrinsic" risk factors. An early diagnosis and prompt surgical treatment yields good results.

Cholecystectomy↗
PubMed2005

Embolization of a ruptured pseudoaneurysm with massive hemorrhage following pancreas transplantation: a case report.

Pseudoaneurysm associated with an arterioenteric fistula is rare, but its clinical manifestations may represent a dramatic event that involves diagnostic and therapeutic problems. We report a case of an arterioduodenal fistula related to a ruptured pseudoaneurysm after simultaneous pancreas-kidney transplantation (SPK) with massive gastrointestinal hemorrhage treated by embolization of the Y graft. A 51-year-old man with type I diabetes and end-stage renal disease underwent SPK. No rejection episodes were documented; the patient was discharged with normal pancreatic and renal function. Two months later the patient was readmitted for an episode of massive lower digestive bleeding and hypotension. The Y-graft was embolized in order to obtain a prompt arrest of the bleeding. The procedure was successful and the patient progressively recovered. Once the hypovolemia was completely corrected, the graft was removed. An arterioenteric fistula between donor mesenteric artery and duodenum was confirmed. Few reports exist in the literature regarding the development of a pseudoaneurysm after pancreas transplantation. To our best knowledge only one case of pseudoaneurysm rupture into donor duodenum has been recently published. In our case angiography recognized the site of the pseudoaneurysm and its rupture into donor duodenum. Embolization of the Y-graft appeared the most rapid, simple, and safe approach to obtain the prompt arrest of the massive bleeding. Embolization of the Y-graft may represent a valid option in the presence of life-threatening hemorrhage.

Aneurysm, False↗
PubMed2004

Renal vein extension in right kidney transplantation.

A short right renal vein may be associated with technical problems in renal transplantation. For this reason, a vena caval extension may be useful to improve exposure of the anastomosis and graft placement. This report evaluates the safety and the effectiveness of renal vein extension, which was routinely performed in right renal transplantation. From April 1986 to December 2002, we performed 371 right kidney transplantations with 252 using the standard technique (group A) and 119 using the renal vein extension (group B). No statistical differences were found between the 2 groups in terms of renal vein thrombosis incidence, delayed graft function, morbidity, and graft loss. Indeed, mean warm ischemia time was reduced in the venoplasty group. In conclusion, renal vein extension is an easy, safe technique that reduces warm ischemia time. We suggest more extensive use of this procedure in right kidney transplantation.

Functional Laterality↗
PubMed2004

Pancreas preservation with University of Wisconsin and Celsior solutions.

BACKGROUND: Although the use of Celsior has been recently described for heart, lung, liver, and kidney transplantation, no data are available on its use for clinical pancreas preservation. METHODS: We herein describe the results of 112 pancreas transplants preserved with either University of Wisconsin (UW; (n = 56) or Celsior (n = 56) solution at two Italian transplant centers. The groups were comparable with regard to all donor and recipient characteristics. RESULTS: Mean cold and warm ischemia times were 10.1 +/- 2.2 hours and 37.2 +/- 8.2 minutes for UW compared to 10.8 +/- 2.4 hours and 38.3 +/- 6.7 minutes for Celsior (P = NS). Delayed endocrine pancreas function was recorded in two UW-preserved grafts (3.6%). Actuarial 1-year patient survival was 94.6% for UW as compared with 100% for Celsior (P = NS). Equivalent graft survival figures were 91.0% for UW as compared with 96.4% for Celsior (P = NS). CONCLUSIONS: Within the range of cold ischemia times reported in this study, UW and Celsior solutions have similar safety profiles for pancreas transplantation.

Adenosine↗
PubMed1996

Transplantation of horseshoe kidneys: a report of four cases.

OBJECTIVE: To increase the awareness of the successful use of horseshoe kidneys in renal transplantation. PATIENTS AND METHODS: Two donors were found to have horseshoe kidneys; these were divided at the midline and transplanted into four recipients. RESULTS: All four recipients had a delayed return of renal function; all eventually functioned with no complications related to the horseshoe kidney. CONCLUSION: Transplantation of horseshoe kidneys has been performed infrequently but they should be considered as suitable for transplants, considering the shortage of cadaver donors and, when possible, should be divided at the isthmus and the halves transplanted into two recipients.

Adult↗
PubMed1994

Antimicrobial prophylaxis with ceftriaxone in renal transplantation. Prospective study of 170 patients.

Due to their uremic state and altered host response induced by immunodepressive therapy, renal transplant recipients are particularly susceptible to infectious complications with high morbidity and mortality. We here report the results of a prospective study with 170 renal transplant patients, undertaken to evaluate the efficacy of ceftriaxone in the prevention of wound and early urinary tract infection. No wound infection was observed, however, 12 patients (7.1%) developed urinary tract infections. On the basis of these data, we recommend ceftriaxone prophylaxis as a safe and effective measure to prevent transplant wound infection and to reduce the incidence of postoperative urinary tract infection.

Adult↗
PubMed1991

[Diagnostic role of ultrasound in the transplanted kidney].

Among diagnostic postoperative procedures in renal cadaver transplantation echographic examination shows high sensitivity and specificity (over 80%). Urographic examination is in fact often dangerous and impossible in non-functioning grafts. Echography can reveal several liquid and solid collections such as hematomas, urinomas, abscesses, lymphatic collections and so on. Urinary obstructions caused by ureteral clots, calculi, external masses can be also detected through echographic examination. Vascular complications can be evaluated through echo and US Doppler examination showing arterial and venous complications. In most of cases acute and chronic graft rejection can be revealed through echo examination whereas in few cases diagnosis can be made only with the help of renal biopsy, laboratory findings and clinical conditions. In conclusion echography is a safe and reliable procedure in renal graft postoperative monitoring.

Follow-Up Studies↗
PubMed1983

Hepatocellular transplantation in rats with toxic induced liver failure: results of iso-, allo- and xenografts.

Intrasplenic hepatocytes transplantation was carried out in Wistar-Lewis strain inbred rats, after inducing acute hepatic failure by intravenous injection of Dimethylnitrosamine (DMNA) (30 mg/kg). Iso-, allo-(CDF-Fisher strain) and xenogeneic (New Zealand White rabbit) grafts were performed. Liver cells suspension was obtained by mechanical separation. The results demonstrated the efficacy of iso- and allotransplants, but not of xenogeneic hepatocytes, in improving significantly the survival rate compared to the control group. It is concluded that immunogenicity of liver cells is a factor which must be taken into consideration in hepatocyte transplantation. Moreover the absence of liver cells into the spleen at one week after the transplant seems to suggest that an intact liver cell is not necessary to improve survival.

Animals↗
PubMedDate not supplied

Percutaneous renal artery embolization of nonfunctioning allograft: preliminary experience.

Percutaneous renal artery embolization has been introduced as an alternative to nephrectomy for patients with a nonfunctioning allograft and Graft Intolerance Syndrome. The symptoms resulting from this syndrome include fever, local pain, hypertension, and hematuria. From April 2003 to October 2003, 5 patients were treated with this technique. The intraparenchymal renal arteries were embolized by injection of calibrated tris-acryl gelatin microspheres of increasing size (from 100-330 to 700-900 microm) and completed with the insertion of 5-mm-8-mm steel coils in the renal artery. The procedure was well tolerated in all cases; no major complications occurred. In 3 patients, the symptoms disappeared immediately. In 1 patient, it was necessary to perform a second embolization due to collateral circulation developing from a lumbar artery; this further procedure resolved the symptoms. In the last case, the patient underwent nephrectomy because of septic fever. In conclusion, patients with this syndrome refractory to medical treatment may be treated by the effective and minimally invasive procedures of percutaneous allograft artery embolization with no significant short-term or late complications.

Balloon Occlusion↗
PubMedDate not supplied

Kidney transplantation from elderly donors: a prospective randomized study comparing celsior and UW solutions.

AIM: The aim of present study was to assess the effect of Celsior as compared with University of Wisconsin (UW) solution on immediate and long-term function of kidney transplants harvested from elderly donors. METHODS: A prospective multicenter randomized study was designed to evaluate the efficacy of Celsior versus UW solution for the clinical preservation of the kidney. Fifty renal transplants were performed from donors over 60 years old. Twenty-five kidneys were stored in Celsior and 25 in UW solution. The groups were comparable with regard to donor and recipient characteristics. Renal function outcomes were compared by evaluating delayed graft function rates, daily urinary output, as well as the evolution of mean serum creatinine at 1, 3, 5, 7, and 15 days. RESULTS: The warm ischemia time was 42.4 +/- 11 minutes among Celsior vs 46.9 +/- 17.9 minutes in the UW cohort (P = NS). The cold ischemia time was 18 +/- 4.5 hours in Celsior and 19 +/- 6.5 hours in UW (P = NS). Delayed graft function occurred in 48% of the Celsior group and in 52% of the UW group (P = NS). Mean serum creatinine levels and mean daily urinary output were also similar. One- and 5-year graft survivals of kidneys preserved with Celsior were 91.8% and 79.3% compared with 96% and 87.4% for UW without any significant statistical difference. CONCLUSIONS: Our data show that the preservation of kidneys from elderly donors in Celsior solution is equivalent to that of UW solution.

Adenosine↗
PubMedDate not supplied

Acute diverticulitis with colon perforation in renal transplantation.

INTRODUCTION: Acute diverticulitis with colon perforation is a serious condition in transplant recipients. The aim of this study was to analyze our experience with colon perforations among 875 renal transplant recipients between January 1986 and September 2004. METHODS: Patients were analyzed by age, gender, steroid dosage, time interval from the transplantation, delay between symptoms and surgery, clinical presentation, surgical procedure, graft and patient outcomes. RESULTS: We identified 8 patients with colon perforation. The incidence of perforation was 0.9%. Mean age at the the time of perforation was 58.5 years. Fever, abdominal pain, localized or diffuse signs of peritonitis, and leukocytosis were present in 7 patients (87.5%). Three patients (37.5%) were on steroid-free immunosuppression, whereas in 2 cases (25%) the steroid dosage was >20 mg/d. The mean interval between transplantation and perforation was 4.1 years. Two episodes (25%) occurred within 1 month following transplantation and the other 6 (75%) between 1 and 15 years. The interval between the onset of symptoms and surgery was longer than 48 hours in 1 patient (12.5%). In 5 cases (62.5%), a Hartmann procedure was performed; in 2 patients (25%), a resection with primary anastomosis was preferred. The last patient had a direct suture of the colon. Mortality rate was 12.5%. At a median follow-up of 6.1 years, 6 patients (75%) are alive with 5 functioning grafts. CONCLUSIONS: Colon perforations in renal transplant recipients remain a challenging surgical problem. An aggressive diagnostic attitude and an immediate surgical treatment may contribute to significantly decrease the incidence and the mortality of this complication.

Colonic Diseases↗
PubMedDate not supplied

[Spontaneous rupture of the ureter].

A case of spontaneous rupture of the ureter initially presented as left acute abdomen in a 71 year old woman is described. A review of the literature has disclosed that in all reported cases a process directly or indirectly leading to the rupture was identified. On the basis of the clinical evolution and the radiological investigations the Authors discuss the diagnosis and the pathogenesis of the observed ureteral rupture.

Aged↗