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.     

亲属活体供肝移植治疗肝豆状核变性时供者的选择

目的总结亲属活体供肝移植治疗肝豆状核变性时选择供者的经验。方法29例肝豆状核变性患者接受亲属活体供肝移植,共有70名供者入选筛查,筛查内容包括肝功能、血清肝炎标记物、肝体积的估测及肝血管和胆管系统解剖结构的预测,以及年龄、体型、供受者配型、伦理学方面的评估等。结果23名供者被排除,10名(43.5%)志愿者是因为受家庭、亲属和社会上的传统观念的影响而最终放弃捐肝意愿;6名(26.1%)因铜代谢指标异常,血清铜蓝蛋白<200mg/L,24h尿铜>100μg;4名(17.4%)因为脂肪肝;3名(13%)因为乙型肝炎。10例为右叶供肝,19例为左叶供肝。供肝重量与受者体重之比为(1.38±0.44)%。所有供者术后恢复正常生活。3名供者术后发生外科相关并发症,其中2例为一过性胆漏,经穿刺引流后治愈,1例为肝断面渗血,经保守治疗痊愈。结论影响供肝选择的主要因素有传统观念、供者铜代谢指标的异常、乙型肝炎及脂肪肝;而术前对供者进行全面评估及供肝切取技术的改进,是保证供者安全和供肝质量的关键。     

Psychosocial evaluation of Chinese living related kidney donors

Zhao W‐Y, Zeng L, Zhu Y‐H, Wang L‐M, Zhou M‐S, Han S, Zhang L. Psychosocial evaluation of Chinese living related kidney donors.
Clin Transplant 2010: 24: 766–771. © 2009 John Wiley & Sons A/S. Abstract: Background: Although living kidney transplantation has numerous advantages over cadaveric transplantation, donor apprehension remains a problem. This study investigated psychosocial features and quality of life in Chinese living kidney donors after transplantation procedures. Methods: Participants were 84 donors interviewed during follow‐up after donation. Sociodemographic characteristics were evaluated by a 22‐item questionnaire. Social support, quality of life, depression, and anxiety were objectively measured with the Social Support Rating Scale for Chinese, the Short‐Form 36 Health Survey, the modified Beck Depression Inventory, and the Self‐Rating Anxiety Scale questionnaire, respectively. Results: All donors volunteered without pressure from families or recipients. Altruistic motives were the main impetus for donation, and donors had good social support. Living transplantation affected donors’ quality of life, with a slight negative effect on some physical aspects. There were no major depressive or anxiety disorders following donation. Conclusions: Living kidney donation was a generally positive experience without evidence of major psychological disturbance. However, considering the limited size and duration of our study, we recommend careful follow‐up of all donors. We also recommend provision of social support services and removal of financial disincentives for donors.     

亲属活体供者供肾前后肾功能的变化

目的 观察亲属活体供者供肾前后肾功能的变化.方法 102名供者均经过严格的术前筛选及评估,其中男性32名,女性70名,供肾时年龄为34～62岁,平均为51.7岁.采用腹腔镜切取供肾74例,开放手术切取供肾28例;其中取左肾90例,取右肾12例.术后对供者进行长期随访,收集术后1 d、7 d、14 d、1个月、3个月、6个月及每年的随访检测资料,检测内容包括血常规、尿常规、血清肌酐(Cr)和尿素氮(BUN)及肾小球滤过率(GFR)等,观察术后不同时期肾功能的变化情况,并与术前进行比较.结果 102例亲属活体供肾切取术均获得成功,术后随访时间为3～99个月,平均37.85个月,供者均健在.供肾术后早期供者的血红蛋白和红细胞计数有所下降,但分别在术后1周和2周后恢复至术前水平;供者的血清Cr水平均有不同程度的升高(P<0.05),但未超出正常范围;除术后第1天供者的血清BUN水平较术前有所升高外(P<0.05),其他随访时间血清BUN水平与术前比较,差异均无统计学意义(P>0.05);术后供者的GFR较术前均有不同程度的升高,从术后2周开始,与术前比较,差异均有统计学意义(P<0.05),其中以术后3个月时的增幅最大;术后各随访时间均未检测出尿蛋白定性呈阳性的供者.结论 活体供肾后,供者的血清Cr水平虽较术前有不同程度的升高,但未超出正常范围,GFR呈代偿性增高,活体供肾是安全的.     

Rewarded gift for living renal donors

Although the waiting list for renal transplantation is growing from year to year, the participation of unrelated living donors in kidney transplantation remains controversial. Patients want to be transplanted as soon as possible, not years later. Nevertheless, cadaveric organ donation has not been able to meet the requirements for all patients in need. With a continuous shortage of organs, the use of living unrelated donors is likely to decrease patient suffering and waiting list mortality. The excellent short- and long-term results of living unrelated transplantation have stimulated physicians toward a wider use of this donor pool. Therefore, transplants from living donors, whether related or unrelated, may be proposed as a therapeutic option for end-stage renal disease patients. In this article we explain the necessity of compensating altruistic living donors as an incentive. It is concluded that living unrelated renal transplantation programs should be legalized and controlled by international and national transplant societies to prevent illegal trade and to provide better care for donors.     

Helical computed tomography angiography in the evaluation of Chinese living renal donors

OBJECTIVE: To determine the suitability of helical computed tomography angiography (CTA), recently used in the anatomical evaluation of potential living renal donors (LRDs) in the Caucasian population, for Chinese LRDs. SUBJECTS AND METHODS: Eighteen consecutive potential LRD candidates underwent both CTA and conventional renal angiography (CRA). Results from each were interpreted while unaware of the results from the other. Renal function was monitored after each radiological procedure. RESULTS: Both procedures were able to identify all four accessory renal arteries present. One prehilar branch of < 1 mm in diameter was not recognized on CTA. Renal artery ostial stenosis in one subject with normal blood pressure was identified on CTA, but not on CRA. CTA better delineated the renal venous and parenchymal anatomy and cost 60% less than CRA. There was no change in renal function after either procedure. CONCLUSION: Despite there being few subjects. CTA has potential value as an alternative to CRA for the anatomical assessment of potential LRDs in Hong Kong. Advantages include a short examination time, non-invasiveness and lower cost. CTA may provide an opportunity to living-related and unrelated renal donor transplantation in this conservative Chinese culture.     

Role of multidetector-row computed tomography in evaluation of living renal donors

Objectives

To assess the value of multidetector-row computed tomography (MDCT) in evaluation of the anatomy of living kidney donors and to reveal the prevalence of renal vascular variations in a Chinese population.

Patients and Methods

One hundred four potential donors underwent MDCT, and the data sets were postprocessed for reformatted images using maximum intensity projection, a volume-rendering technique, and multiplanar re-formation. Nephrectomy was performed in 97 donors, which enabled correlation of MDCT evaluation with the actual anatomy at surgery as the standard of reference.

Results

The MDCT images accurately demonstrated the anatomical structure of the main renal arteries and veins and the upper part of the ureters. The prevalence of accessory arteries was 41.7% (43 of 103), and of early branching was 12.6% (13 of 103). Compared with findings during surgery, the detection rate of accessory arteries on MDCT images was 91.3% (21 of 23), of larger accessory arteries (>1.5 mm in diameter) was 100%, and of early branching was 100%.

Conclusion

Multidetector-row computed tomography is helpful in accurately evaluating the renal anatomy of potential donors, thus facilitating planning of surgery.     

Preoperative evaluation of living renal donors with gadolinium-enhanced magnetic resonance angiography

BACKGROUND: Preoperative evaluation of living renal donors includes an intra-arterial digital subtraction angiography (DSA). Inasmuch as this technique is invasive, uses radiation and an iodine-containing contrast medium, an alternative technique would be preferable. The purpose of this study was to determine the accuracy of gadolinium-enhanced magnetic resonance (MR) angiography in the visualization of renovascular anatomy for the preoperative evaluation of renal donors. METHODS: Twenty-four consecutive potential renal donors underwent gadolinium-enhanced MR angiography before the standard of reference, intra-arterial DSA. Both modalities were evaluated in a blinded manner. The results were correlated with the surgical findings. RESULTS: Three MR angiograms were technically unacceptable because of inadequate breath-hold. The remaining 21 donors had 47 renal arteries, including 5 accessory renal arteries, which were all visualized by MR angiography. MR angiography failed to visualize one case of subtle fibromuscular dysplasia in the distal part of a renal artery. In one donor, a small accessory renal artery, which had not been visualized on DSA, was encountered during nephrectomy. CONCLUSION: Gadolinium-enhanced MR angiography is an accurate minimally invasive method for the detection of accessory renal arteries in the preoperative evaluation of potential renal donors. The accuracy for excluding stenosis in general is high; however, the depiction of stenosis that are located far distally, or in the branch vessels, is less accurate. Advantages of gadolinium-enhanced MR angiography over the currently used method, intra-arterial DSA, are the minimal invasive nature, lower costs, and superiority in detecting venous anomalies, renal cysts, and tumors.     

亲属活体供肾者术后心理状态调查和分析

目的 分析与研究亲属活体供肾者术前一般情况和术后心理状态.方法 应用自编个人资料问卷、社会支持评定量表、SF-36量表、Beck抑郁自评量表和Zung焦虑自评量表(SAS)对56名活体供肾者术后6个月至4年时的心理状态进行调查分析.结果 供者以女性、农村中低收入、低学历者居多,所有供者自愿捐肾.供者术后客观和主观支持良好,支持利用度稍差.供者术后躯体健康质量稍差,精神健康较好,无抑郁和焦虑状态.结论 亲属活体供.肾者术后的心理状态较好,但临床工作者仍应适时采取心理干预,加强健康教育,同时社会应加强宣教,术后应给予供者良好的社会支持.     

活体肝移植供体的选择及术后评估28例

目的探讨活体肝移植供体的选择标准 ,评估其术后状况。方法回顾总结 1995年1月至 2 0 0 3年 7月 2 8例活体肝移植供体术前检查、选择标准 ;术后随访其肝肾等重要脏器功能、并发症情况。结果 2 8例供体平均住院日为 10 (8～ 2 0 )d。本组 1例术后发生肝脏断面渗血 ,经保守治疗后痊愈。 1例在“T”形管拔除后发生胆漏 ,经手术引流后痊愈。其余 2 6例无并发症出现。随访时间 2个月至 8年。所有供体均恢复正常体力活动。结论保证供体的安全是开展活体肝移植的首要原则。在具备丰富肝脏手术经验的基础上 ,供体手术是安全、可行的。     

Urologic complications of extravesical ureteroneocystostomy in renal transplantation from living related donors

INTRODUCTION: Reconstruction of the urinary system during renal transplantation is usually performed with antirefluxive ureteroneocystostomy techniques and extravesical methods are usually preferred. MATERIAL AND METHODS: Between 1983 and 1997, 241 renal transplantations from living donors were performed at our institution. A variation of the Lich-Gregoir technique was used as the ureteroneocystostomy method in all cases. RESULTS: A total of 12 (4.9%) urologic complications were observed. Urinary fistula developed in 5 (2%) cases and were explored surgically during the early postoperative period. Postoperative vesicoureteral reflux (VUR) to the transplanted kidney was identified in 7 (2.9%) cases. Either endoscopic or surgical interventions resolved VUR in 4 cases while the other 3 did not need further treatment. No ureteral stenosis was observed. There was no loss of graft due to urologic complications. CONCLUSIONS: Urologic complications after renal transplantation are reported to be about 7% and ischemia is blamed as the major contributing factor. Preparation of the native ureter during donor nephrectomy and preservation of distal periureteral fatty tissue, anastomosis technique variations in vascular anatomy, rejections and medications are the major factors determining the ischemia.     

Accuracy of three-dimensional CT angiography for preoperative vascular evaluation of laparoscopic living renal donors

PURPOSE: A retrospective review of preoperative three-dimensional (3D) CT and the operative findings during laparoscopic donor nephrectomy. PATIENTS AND METHODS: Fifty-four consecutive patients underwent laparoscopic donor nephrectomy. Of these patients, 51 had preoperative 3D reconstructed CT scans. Each radiologic report was compared with the operative report. RESULTS: The 3D CT correctly identified the arteries in 98% of the patients and the veins in 96%. CONCLUSIONS: Preoperative CT angiography can accurately identify the renal vasculature.