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Figure 1. Kidney transplantation in the Netherlands (1996-2008) In 1902 the first successful experimental kidney transplants were performed at the Vienna Medical School in Austria*. Emerich Ullmann (1861-1937) transplanted a kidney from one dog to another. A few years later in 1906, Mathieu Jaboulay (1860-1913), professor of Sur- gery in Lyon, France, connected the renal vessels of a sheep’s and a pig’s kidney, respectively, to the brachial vessels of two patients who were dying of renal failure’. Neither kidney func- tioned, but these were the first transplants, albeit xenografts, to be placed in humans. The techniques used to join the vessels together during transplantation were those developed techniques used to join the vessels together during transplantation were those developed

Figure 1 Kidney transplantation in the Netherlands (1996-2008) In 1902 the first successful experimental kidney transplants were performed at the Vienna Medical School in Austria*. Emerich Ullmann (1861-1937) transplanted a kidney from one dog to another. A few years later in 1906, Mathieu Jaboulay (1860-1913), professor of Sur- gery in Lyon, France, connected the renal vessels of a sheep’s and a pig’s kidney, respectively, to the brachial vessels of two patients who were dying of renal failure’. Neither kidney func- tioned, but these were the first transplants, albeit xenografts, to be placed in humans. The techniques used to join the vessels together during transplantation were those developed techniques used to join the vessels together during transplantation were those developed

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1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Figure 2. Kidney transplantation in the Academic Medical Center, Amsterdam (1986-2008) and described by Alexis Carrel (1873-1944), who was a young surgeon in Jaboulay’s unit, and in fact, the techniques of vascular anastomosis described by Carrel are exactly the same as those still in use in kidney transplantation today". For these efforts, Carrel was awarded the 1912 Nobel Prize in Physiology or Medicine.
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Figure 2. Kidney transplantation in the Academic Medical Center, Amsterdam (1986-2008) and described by Alexis Carrel (1873-1944), who was a young surgeon in Jaboulay’s unit, and in fact, the techniques of vascular anastomosis described by Carrel are exactly the same as those still in use in kidney transplantation today". For these efforts, Carrel was awarded the 1912 Nobel Prize in Physiology or Medicine.
A group particularly liable to end stage renal failure is the population of the Dutch Carib- bean with an estimated prevalence of 145 per 100 000 residents*, one of the highest in the world. In 1998, the St. Elisabeth Hospital in Curacao and in 2003 the Dr. Horacio E. Oduber Hospital in Aruba, began a collaboration with the Academic Medical Center in Amsterdam, the Netherlands, the Eurotransplant Foundation, Sanquin Diagnostic Services and the Dutch Transplantation Working Group in order to set up a structured transplanta- tion programme for patients in the Dutch Caribbean who would otherwise need lifelong dialysis. These patients were offered the opportunity to be put on the Eurotransplant waiting list to receive a deceased donor kidney or to participate in the living donor transplantation programme, if a living donor became available. The results of this unique transplantation programme are discussed in this thesis. “igure 3. Graft survival in the Netherlands. The black line represents the living donor kidney
A group particularly liable to end stage renal failure is the population of the Dutch Carib- bean with an estimated prevalence of 145 per 100 000 residents*, one of the highest in the world. In 1998, the St. Elisabeth Hospital in Curacao and in 2003 the Dr. Horacio E. Oduber Hospital in Aruba, began a collaboration with the Academic Medical Center in Amsterdam, the Netherlands, the Eurotransplant Foundation, Sanquin Diagnostic Services and the Dutch Transplantation Working Group in order to set up a structured transplanta- tion programme for patients in the Dutch Caribbean who would otherwise need lifelong dialysis. These patients were offered the opportunity to be put on the Eurotransplant waiting list to receive a deceased donor kidney or to participate in the living donor transplantation programme, if a living donor became available. The results of this unique transplantation programme are discussed in this thesis. “igure 3. Graft survival in the Netherlands. The black line represents the living donor kidney
'y? test or Mann-Whitney U Test; NA = not applicable; WIT = warm ischemic time Table 1. Characteristics of the 202 living kidney donors
'y? test or Mann-Whitney U Test; NA = not applicable; WIT = warm ischemic time Table 1. Characteristics of the 202 living kidney donors
Table 2. Number of preoperative and postoperative complications. recipient morbidity after laparoscopic donor nephrectomy”"’. The present study indicates equal donor and recipient morbidity for both groups. The complication rate in the HALD donor groups was slightly higher and these were all minor complications. The difference in numbers of preoperative and postoperative complications can be explained by the com- plications of the prospectively followed HALD group being more accurate. This bias can especially be more prominent in the minor complication group. hes fa mitlhend maa lennwneKkne ~~ tarbewtwmwamewe wonk tended aewtathcsn ne clock eax bemawiocwnnr
Table 2. Number of preoperative and postoperative complications. recipient morbidity after laparoscopic donor nephrectomy”"’. The present study indicates equal donor and recipient morbidity for both groups. The complication rate in the HALD donor groups was slightly higher and these were all minor complications. The difference in numbers of preoperative and postoperative complications can be explained by the com- plications of the prospectively followed HALD group being more accurate. This bias can especially be more prominent in the minor complication group. hes fa mitlhend maa lennwneKkne ~~ tarbewtwmwamewe wonk tended aewtathcsn ne clock eax bemawiocwnnr
Table 3. Characteristics of the renal transplant recipients 'y? test or Mann-Whitney U Test; * log-rank test; ? no need for post-transplant dialysis,
Table 3. Characteristics of the renal transplant recipients 'y? test or Mann-Whitney U Test; * log-rank test; ? no need for post-transplant dialysis,
"y? test; ? Mann-Whitney U Test; * log rank; Tabel 1. Baseline characteristics, surgical and postoperative outcomes. necessary to introduce an extra 5-mm trocar during the operation to assist in controlling the bleeding. None of the patients with a serosal lesion of the colon needed a colonic repair. All polar artery lesions were repaired successfully before implantation. Minor postoperative complications after left HALDN were a swollen testicle and a supraventricular tachycardia. Both were treated conservatively. No minor postoperative complications occurred in the right HALDN group. No major postoperative complications occurred in either group. sht HALDN group. No major postoperative complications occurred in either group.
"y? test; ? Mann-Whitney U Test; * log rank; Tabel 1. Baseline characteristics, surgical and postoperative outcomes. necessary to introduce an extra 5-mm trocar during the operation to assist in controlling the bleeding. None of the patients with a serosal lesion of the colon needed a colonic repair. All polar artery lesions were repaired successfully before implantation. Minor postoperative complications after left HALDN were a swollen testicle and a supraventricular tachycardia. Both were treated conservatively. No minor postoperative complications occurred in the right HALDN group. No major postoperative complications occurred in either group. sht HALDN group. No major postoperative complications occurred in either group.
Recipient Figure 2. Operating time of the left and right donor nephrectomy. The horizontal line in the box represents the median. The boxes denote the 25th and 75th percentile while the thin vertical line extenc to the minimum and maximum. Median operating time for transplantation was 138 min (range 99-229) in the left group and 148 min (range 107-267) in the right group (P=0.379). No grafts were used for vascular reconstruction. A total of 58 kidneys were transplanted to the right iliac fossa and two into the left fossa. Four renal grafts required arterial reconstruction due to two renal arteries. In all cases, a common ostium was performed. There was no statistically significant difference between both groups in the number of patients with a urological complication. No graft thrombosis occurred in both groups. Delayed graft function occurred in two patients: one in the left group and the other in the right group. One-year graft survival rate was 96% in the left group versus 93% in the right group (P=0.625, log rank). Three grafts were lost during follow-up (one left and two right kidneys), all caused by histological proven humoral rejection, resistant against immunosuppressive drug therapy and plasmapheresis. They were lost at 26, 27, and 112 days after the operation.
Recipient Figure 2. Operating time of the left and right donor nephrectomy. The horizontal line in the box represents the median. The boxes denote the 25th and 75th percentile while the thin vertical line extenc to the minimum and maximum. Median operating time for transplantation was 138 min (range 99-229) in the left group and 148 min (range 107-267) in the right group (P=0.379). No grafts were used for vascular reconstruction. A total of 58 kidneys were transplanted to the right iliac fossa and two into the left fossa. Four renal grafts required arterial reconstruction due to two renal arteries. In all cases, a common ostium was performed. There was no statistically significant difference between both groups in the number of patients with a urological complication. No graft thrombosis occurred in both groups. Delayed graft function occurred in two patients: one in the left group and the other in the right group. One-year graft survival rate was 96% in the left group versus 93% in the right group (P=0.625, log rank). Three grafts were lost during follow-up (one left and two right kidneys), all caused by histological proven humoral rejection, resistant against immunosuppressive drug therapy and plasmapheresis. They were lost at 26, 27, and 112 days after the operation.
Figure 3. Postoperative pain as measured with VAS scores (mean + 2 SEM). The x-axis represents the time after surgery. We demonstrated that right-sided HALDN is associated with a significantly shorter operating time of a median of 30 min. The shorter operation time for the right HALDN is probably the result of the lower position of the right kidney, less extensive colonic dissection needed for right-sided HALDN, and no side-branches of the right renal vein. Many surgeons prefer the left kidney for a donor nephrectomy because of the longer renal vein, which makes implantation less demanding'®'’. However, drawbacks of the left-sided HALDN are higher chance of lacerating the spleen during laparoscopic mobilization of the splenic flexure of the colon and handling of the lumbar and supra-adrenal side branches of the left renal vein. A major drawback for using the right kidney is the shorter length of the renal vein. Transection of the renal vein with a laparoscopic vascular stapler leads to additional loss of available length necessary for implantation. Additional drawbacks are the need for liver displacement, potentially caval vein bleeding and the increased incidence of vascular thrombosis as reported in some studies’’. In our study, no renal vein thrombosis occurred and we did not have to use any additional venous reconstruction to extend the right renal vein. Figure 3. Postoperative pain as measured with VAS scores (mean + 2 SEM). The x-axis represents the time
Figure 3. Postoperative pain as measured with VAS scores (mean + 2 SEM). The x-axis represents the time after surgery. We demonstrated that right-sided HALDN is associated with a significantly shorter operating time of a median of 30 min. The shorter operation time for the right HALDN is probably the result of the lower position of the right kidney, less extensive colonic dissection needed for right-sided HALDN, and no side-branches of the right renal vein. Many surgeons prefer the left kidney for a donor nephrectomy because of the longer renal vein, which makes implantation less demanding'®'’. However, drawbacks of the left-sided HALDN are higher chance of lacerating the spleen during laparoscopic mobilization of the splenic flexure of the colon and handling of the lumbar and supra-adrenal side branches of the left renal vein. A major drawback for using the right kidney is the shorter length of the renal vein. Transection of the renal vein with a laparoscopic vascular stapler leads to additional loss of available length necessary for implantation. Additional drawbacks are the need for liver displacement, potentially caval vein bleeding and the increased incidence of vascular thrombosis as reported in some studies’’. In our study, no renal vein thrombosis occurred and we did not have to use any additional venous reconstruction to extend the right renal vein. Figure 3. Postoperative pain as measured with VAS scores (mean + 2 SEM). The x-axis represents the time
Figure 4. Pre- and postoperative results as measured with SF-36 questionnaire (mean + 2 SEM). The x-axis represents the time when the questionnaires were done. One of the eight dimensions is presented physical functioning. Figure 5. Pre- and postoperative results as measured with GIQLI questionnaire (mean + 2 SEM). The x-axis represents the time when the questionnaires were done.
Figure 4. Pre- and postoperative results as measured with SF-36 questionnaire (mean + 2 SEM). The x-axis represents the time when the questionnaires were done. One of the eight dimensions is presented physical functioning. Figure 5. Pre- and postoperative results as measured with GIQLI questionnaire (mean + 2 SEM). The x-axis represents the time when the questionnaires were done.
The operating time for the left donor nephrectomy may be reduced by using a midline incision instead of a Pfannenstiel incision’. With this approach, the upper pole of the lef kidney may be easier to reach with the nondominant operators’ hand. This may lead to les: traction on the vessels and a lower risk of spleen laceration. However, the midline incisior is more visibly prominent on the abdomen and is cosmetically inferior to the Pfannenstie incision.
The operating time for the left donor nephrectomy may be reduced by using a midline incision instead of a Pfannenstiel incision’. With this approach, the upper pole of the lef kidney may be easier to reach with the nondominant operators’ hand. This may lead to les: traction on the vessels and a lower risk of spleen laceration. However, the midline incisior is more visibly prominent on the abdomen and is cosmetically inferior to the Pfannenstie incision.
Table 1: Demographics of donors and recipients
Table 1: Demographics of donors and recipients
Table 2. Postoperative donor complications tion was necessary and two patients needed ligation of an accessory renal vein. Nine patients of the DGF group underwent a postoperative kidney biopsy. The histologi: results of the core biopsies showed in 6 patients an acute humoral rejection and in 3 patient: an acute tubular necrosis. Univariate logistic regression analysis showed 2 donor risk factor: and 2 recipient risk factors with a significant correlation with DGF (Table 3). The two dono: factors were counts per second on Tmax (corrected for BMI; odds ratio (OR) 15.33, 95% confidence interval (CI): 2.96-79.02) and multiple renal veins (OR 6.04, 95% CI: 1.24-29.45) consisting of 2 right renal veins and 1 left renal vein. The two recipient factors were two o1 more renal transplantations (OR 4.45, 95% CI: 1.22-16.20) and acute rejection (OR 22.65 95% CI: 4.75-108.1). Multivariate analysis revealed an increased risk of delayed function fo: presence of multiple renal veins (OR 151.57, 95%CI: 2.53-9093.86) and acute rejection (OF 78.87, 95%CI: 3.17-1959.62).
Table 2. Postoperative donor complications tion was necessary and two patients needed ligation of an accessory renal vein. Nine patients of the DGF group underwent a postoperative kidney biopsy. The histologi: results of the core biopsies showed in 6 patients an acute humoral rejection and in 3 patient: an acute tubular necrosis. Univariate logistic regression analysis showed 2 donor risk factor: and 2 recipient risk factors with a significant correlation with DGF (Table 3). The two dono: factors were counts per second on Tmax (corrected for BMI; odds ratio (OR) 15.33, 95% confidence interval (CI): 2.96-79.02) and multiple renal veins (OR 6.04, 95% CI: 1.24-29.45) consisting of 2 right renal veins and 1 left renal vein. The two recipient factors were two o1 more renal transplantations (OR 4.45, 95% CI: 1.22-16.20) and acute rejection (OR 22.65 95% CI: 4.75-108.1). Multivariate analysis revealed an increased risk of delayed function fo: presence of multiple renal veins (OR 151.57, 95%CI: 2.53-9093.86) and acute rejection (OF 78.87, 95%CI: 3.17-1959.62).
Table 3: Risk factors for delayed graft function. Values in parentheses are * percentages or '95 per cent confidence intervals ? corrected for body mass index
Table 3: Risk factors for delayed graft function. Values in parentheses are * percentages or '95 per cent confidence intervals ? corrected for body mass index
'y? test, 7 Mann-Whitney U Test, BMI = Body Mass Index Table 1: Baseline characteristics of donors
'y? test, 7 Mann-Whitney U Test, BMI = Body Mass Index Table 1: Baseline characteristics of donors
"test, ? Mann-Whitney U Test, * log rank Donor characteristics are presented in Table 1, showing no significant difference between the two groups. Surgical and postoperative outcome of donors and recipients are shown in Table 2. Forty-two percent of the elderly recipient received an older kidney, whereas 25% of the younger recipients received an older kidney. There were no conversions in both groups. There was no sig nificant difference between both groups in surgical complications. The
"test, ? Mann-Whitney U Test, * log rank Donor characteristics are presented in Table 1, showing no significant difference between the two groups. Surgical and postoperative outcome of donors and recipients are shown in Table 2. Forty-two percent of the elderly recipient received an older kidney, whereas 25% of the younger recipients received an older kidney. There were no conversions in both groups. There was no sig nificant difference between both groups in surgical complications. The
Figure 2. Pre- and postoperative results as measured by the MFI-20 questionnaire (mean + 2xSEM). The x-axis represents the time when the questionnaires were held. Figure 2. Pre- and postoperative results as measured by the MFI-20 questionnaire (mean + 2xSEM). The Pain VAS scores
Figure 2. Pre- and postoperative results as measured by the MFI-20 questionnaire (mean + 2xSEM). The x-axis represents the time when the questionnaires were held. Figure 2. Pre- and postoperative results as measured by the MFI-20 questionnaire (mean + 2xSEM). The Pain VAS scores
Figure 3. Postoperative pain in rest and during moving as measured by VAS scores (mean + 2xSEM). The x-axis represents the time in days after surgery. Asterisks indicate a significant difference.
Figure 3. Postoperative pain in rest and during moving as measured by VAS scores (mean + 2xSEM). The x-axis represents the time in days after surgery. Asterisks indicate a significant difference.
Table 1. Univariate analysis of vascular reconstructions and other factors and 1-week graft failure Values in parentheses are ' percentages or 795 per cent confidence intervals. venous reconstruction had a significant increased risk of 1-week graft failure (OR, 7.15 95% CI, 1.17- 43.60) compared with patients without a venous reconstruction. Subgrouy analysis of the venous reconstructions revealed that there was an increased risk of 1-weel graft failure, especially if the reconstruction was performed without using the caval veir (OR, 27.24; 95% CI, 4.24 -176.04). Caval extension of the main renal vein or ligation o: accessory renal veins did not significantly increase the risk of 1-week graft failure. Recipien arterial reconstruction had no significant effect on the 1-week graft failure rate. Because venous reconstructions were the only variable with P < 0.20, a multivariate analysis was no’ a 7
Table 1. Univariate analysis of vascular reconstructions and other factors and 1-week graft failure Values in parentheses are ' percentages or 795 per cent confidence intervals. venous reconstruction had a significant increased risk of 1-week graft failure (OR, 7.15 95% CI, 1.17- 43.60) compared with patients without a venous reconstruction. Subgrouy analysis of the venous reconstructions revealed that there was an increased risk of 1-weel graft failure, especially if the reconstruction was performed without using the caval veir (OR, 27.24; 95% CI, 4.24 -176.04). Caval extension of the main renal vein or ligation o: accessory renal veins did not significantly increase the risk of 1-week graft failure. Recipien arterial reconstruction had no significant effect on the 1-week graft failure rate. Because venous reconstructions were the only variable with P < 0.20, a multivariate analysis was no’ a 7
Of the 62 grafts with an accompanying urological complication, seven were lost withir the first postoperative year. The causes of graft loss were: two acute rejections, two instance: of sepsis, one infected hematoma, one renal artery thrombus and one of unknown origin The 1-month and 1-year graft survival rates in patients without urological complication: were 98% and 92%, respectively, compared with 92% and 86% in patients with urologica complications. The 1-year survival rate of patients with and without urological complica tions was 95% and 97%, respectively. The occurrence of a urological complication had nc significant effect on the graft (P = 0.23) or patient (P = 0.87) 1-year survival rate. Figure 1. Time interval between the operation and occurrence of the urological complication in the postoperative period.
Of the 62 grafts with an accompanying urological complication, seven were lost withir the first postoperative year. The causes of graft loss were: two acute rejections, two instance: of sepsis, one infected hematoma, one renal artery thrombus and one of unknown origin The 1-month and 1-year graft survival rates in patients without urological complication: were 98% and 92%, respectively, compared with 92% and 86% in patients with urologica complications. The 1-year survival rate of patients with and without urological complica tions was 95% and 97%, respectively. The occurrence of a urological complication had nc significant effect on the graft (P = 0.23) or patient (P = 0.87) 1-year survival rate. Figure 1. Time interval between the operation and occurrence of the urological complication in the postoperative period.
Values in parentheses are * percentages or ' 95 per cent confidence intervals. 2: A lower pole artery was present (30 revascularized and 8 ligated). 3: Ligation of a lower pole artery which could not be revascularized. Table 1. Univariate and multivariate analysis of risk factors for urological complications.
Values in parentheses are * percentages or ' 95 per cent confidence intervals. 2: A lower pole artery was present (30 revascularized and 8 ligated). 3: Ligation of a lower pole artery which could not be revascularized. Table 1. Univariate and multivariate analysis of risk factors for urological complications.
Table 1: Demographics of donors and recipients complications included 10 ureteral strictures and 3 ureteral leaks. In 8 of these 13 patients, the urological complication was managed using a temporary percutaneous nephrostomy catheter only. In the remaining five, surgical revision (a neo-ureterocystostomy) was neces- sary to correct the urological complication. In the non-stented group, the 21 urological complications included 15 ureteral strictures and 6 ureteral leaks. In 15 of these 21 patients, the urological complication was managed using a temporary percutaneous nephrostomy catheter only. The remaining six underwent a surgical revision. In both groups, no recurrent urological complication occurred after this operation and no reoperations were necessary. In both groups, the greater majority of all complications occurred within the first postopera- tive month (Figure 1). After placement, the percutaneous nephrostomy catheter remained in situ for varying lengths of time. The mean (+ SD) percutaneous nephrostomy catheter time (days) was 146 + 40 (range 12-411) in the stented group and 155 + 45 (range 17-440) in the non-stented group. Urinary tract infection in the stented group occurred in 41 patients (20.9%) compared to 45 patients (22.9%) in the non-stented group p = 0.689. The surgical outcome is shown in Table 2. In the firet 5 dave. the nrinary outnut voliimes
Table 1: Demographics of donors and recipients complications included 10 ureteral strictures and 3 ureteral leaks. In 8 of these 13 patients, the urological complication was managed using a temporary percutaneous nephrostomy catheter only. In the remaining five, surgical revision (a neo-ureterocystostomy) was neces- sary to correct the urological complication. In the non-stented group, the 21 urological complications included 15 ureteral strictures and 6 ureteral leaks. In 15 of these 21 patients, the urological complication was managed using a temporary percutaneous nephrostomy catheter only. The remaining six underwent a surgical revision. In both groups, no recurrent urological complication occurred after this operation and no reoperations were necessary. In both groups, the greater majority of all complications occurred within the first postopera- tive month (Figure 1). After placement, the percutaneous nephrostomy catheter remained in situ for varying lengths of time. The mean (+ SD) percutaneous nephrostomy catheter time (days) was 146 + 40 (range 12-411) in the stented group and 155 + 45 (range 17-440) in the non-stented group. Urinary tract infection in the stented group occurred in 41 patients (20.9%) compared to 45 patients (22.9%) in the non-stented group p = 0.689. The surgical outcome is shown in Table 2. In the firet 5 dave. the nrinary outnut voliimes
output volume through the indwelling bladder catheter between these groups were found (p=0.278). The 1-month graft survival rate in patients with a urological stent was 93% (1/196) com- pared with 93% (2/196) in patients without a urological stent. The 1-year graft survival in patients with a urological stent was 89% (8/196) and without a urological stent was 89% (14/196) (p = 0.968).
output volume through the indwelling bladder catheter between these groups were found (p=0.278). The 1-month graft survival rate in patients with a urological stent was 93% (1/196) com- pared with 93% (2/196) in patients without a urological stent. The 1-year graft survival in patients with a urological stent was 89% (8/196) and without a urological stent was 89% (14/196) (p = 0.968).
Table 1: Primary renal disease of recipients one patient a third kidney transplantation. Donor characteristics are presented in Table 2 Current panel-reactive antibody (PRA) level was 0% to 6% PRA in 35 (85%) and 6% to 85% PRA in 6 (15%). Historical panel reactivity was 0% to 6% PRA in 25 (61%), 6% to 85% PRA in 13 (32%) and 2 patients (5%) with more than 85% PRA (Table 3). In 3 transplantation: no mismatches were present between the donor and recipient. One or two HLA mismatche: were present in 9 (22%) patients, 3 or 4 HLA mismatches in 20 (49%) and 5 or 6 HLA mismatches in 9 (22%) patients. Twenty-nine patients (71%) received a graft mismatchec for 1 HLA-DR allele. In 38 donors University of Wisconsin preservation solution was use¢ and in 3 donors kidney Histidine-Tryptophan-Ketoglutarate (HTK) solution.
Table 1: Primary renal disease of recipients one patient a third kidney transplantation. Donor characteristics are presented in Table 2 Current panel-reactive antibody (PRA) level was 0% to 6% PRA in 35 (85%) and 6% to 85% PRA in 6 (15%). Historical panel reactivity was 0% to 6% PRA in 25 (61%), 6% to 85% PRA in 13 (32%) and 2 patients (5%) with more than 85% PRA (Table 3). In 3 transplantation: no mismatches were present between the donor and recipient. One or two HLA mismatche: were present in 9 (22%) patients, 3 or 4 HLA mismatches in 20 (49%) and 5 or 6 HLA mismatches in 9 (22%) patients. Twenty-nine patients (71%) received a graft mismatchec for 1 HLA-DR allele. In 38 donors University of Wisconsin preservation solution was use¢ and in 3 donors kidney Histidine-Tryptophan-Ketoglutarate (HTK) solution.
Table 2: Donor characteristics Surgical technique
Table 2: Donor characteristics Surgical technique
Table 3 Immunological characteristics reconstructions were performed in four cases, venous reconstructions in three of which one was performed with a Poly Tetra Fluor Ethylene (PTFE) graft. Intraoperative complications occurred in 2 recipients (5%): during implantation the renal artery ruptured in 2 recipients requiring sutures for repair.
Table 3 Immunological characteristics reconstructions were performed in four cases, venous reconstructions in three of which one was performed with a Poly Tetra Fluor Ethylene (PTFE) graft. Intraoperative complications occurred in 2 recipients (5%): during implantation the renal artery ruptured in 2 recipients requiring sutures for repair.
Table 4: Postoperative outcome Table 5: Characteristics of the kidney graft losses
Table 4: Postoperative outcome Table 5: Characteristics of the kidney graft losses
immune suppression 0 = prednisone, a calcineurin inhibitor and mycophenolate mofetil immune suppression 1 = prednisone, a calcineurin inhibitor, mycophenolate mofetil and basiliximab CIT = cold ischemia time in minutes
immune suppression 0 = prednisone, a calcineurin inhibitor and mycophenolate mofetil immune suppression 1 = prednisone, a calcineurin inhibitor, mycophenolate mofetil and basiliximab CIT = cold ischemia time in minutes
Figure 1. Renal graft survival at one year. The dashed line represents the transatlantic group and the other line represents the reference group. presence of significant barriers to access to transplantation services for racial minorities. women, and patients with low socioeconomic status or inadequate insurance!*!’. The factors contributing to this disparity in access to renal transplantation, include perceived differences in patient preferences, differential rates and timing of referrals, variation in the rates and timeliness of the completion of transplant evaluations, and organ allocation poli- cies favoring highly matched donors and recipients'**’. Another explanation for disparity in 23,24 access to renal transplantation is remote living location Several factors micht exnlain our 1-_-vear oraft survival rate First. mean cold ischemia time presence of significant barriers to access to transplantation services for racial minorities,
Figure 1. Renal graft survival at one year. The dashed line represents the transatlantic group and the other line represents the reference group. presence of significant barriers to access to transplantation services for racial minorities. women, and patients with low socioeconomic status or inadequate insurance!*!’. The factors contributing to this disparity in access to renal transplantation, include perceived differences in patient preferences, differential rates and timing of referrals, variation in the rates and timeliness of the completion of transplant evaluations, and organ allocation poli- cies favoring highly matched donors and recipients'**’. Another explanation for disparity in 23,24 access to renal transplantation is remote living location Several factors micht exnlain our 1-_-vear oraft survival rate First. mean cold ischemia time presence of significant barriers to access to transplantation services for racial minorities,
Related topics:
TransplantationKidney TransplantDelayed graft functionFunctional Laterality
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