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Objectives: Shorter length of the right renal vein (RRV) may represent an additional difficulty for transplant. This paper has aimed to present our experience with RRV elongation in the kidney from a cadaveric donor and to compare the results with the rest of kidneys transplanted in the same period of time., Material and Methods: We performed 377 kidneys transplants within the last 11 years. Of these, in 120, the RRV was elongated with the vena cava. The surgical technique is described and the results compared with the remaining transplants of the series. Renal function, graft survival and complications were assessed at 1, 3 and 12 months. Data were obtained retrospectively from the database of the Urology Department and Hospital medical records., Results: In the 377 transplants, there were 4 (1%) venous thrombosis, 2 (1.6%) of which concerned kidneys with elongation of the RRV and 2 (0.7%) in the rest of transplanted kidneys. There was no difference in postoperative bleeding, 11 (9.1%) occurred in kidneys with elongated RRV and 22 (8.5%) in the remaining kidney. In no case was the bleeding related to the elongated segment. Graft survival and renal function were similar for both groups., Conclusions: Elongation of the RRV with the vena cava is a feasible, fast, and effective procedure that does not increase morbidity or affect renal function or graft viability. It facilitates vascular anastomosis and places the kidney in a less forced position, shortens the warm ischemia time and avoids the risk of kinking of the renal artery because it is equal to the length of the vein artery., (Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.)

Introduction: Laparoscopic surgery requires a long training period of time in which the complexity of the training is increased., Goals: The technique presented in this paper has been developed in order to find an experimental model that allows us to improve the learning of the vascular suture. Our main goal was to evaluate this technique as an experimental model for the vacular anastomosis, not to obtain a functional autotransplant. In this regard, here we summarize our experience during the first two cases performed., Material and Methods: Laparoscopic renal autotransplant was perfomed in female lab pigs weighing 15-20 kg. International Experimental Animal Care rules were accomplished., Results: After sacrifizing the animals, only one case of vascular thrombosis was observed. The other cases showed normal arterial and venous flow., Conclusions: Experimental Renal Laparoscopic autotransplant constitutes a good surgical model. We are trying to implement the technique in the clinics in the next future.

An update on aspects and use of different experimental models applied in kidney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart beating organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done.

Introduction and Objectives: Organ transplant is nowadays a usual and succesful practice, although with limited application due to the lack of organs. Yearly thousands of patients get access to the waiting list and finally will death while they are waiting for an organ. In the U.S.A., 2005 waiting list for kidneys, heart, liver lung and pancreas was around 94.419. Number of transplants performed was 27.966 and died patients while waiting for an organ, 41.392 (1). Pig xenotransplant is one of the possibilities to ameliorate the lack of organs for transplant. Arrangement of pigs with different genetic modifications generated great expectatives on the use of these organs in clinics. Although preclinical experimental studies with kidneys reached prolonged survivals, these are really insufficient to go on with the clinical appliance. Hyperacute rejection produces destruction of the organ immediately. This problem could be pharmacologically precluded in xeno-transplant. However, acute rejection or vascular rejection usually produces the lost of the implant. New inmunosuppresive schedules delay significantly rejection, but not definitively. Xenotransplant as a therapeutic option introduces important scientific problems, as well as ethical and social. This paper reports a summary of our experience in renal xenotransplant and the management of acute rejection., Material and Methods: Twenty xenotransplants from transgenic pig (hDAF) as donor to babuine as receptor. Average weight of the animals ranged 11.4-75 kgrs and babuines 10-26 kg. Xenograft average weight ranged 39-160 grs. Implant was performed to aorta and cava. Four inmunosupressive schedules were used., Results: Average survival was 7-9 days. Final Histological findings are described. Changes observed were secondary to acute tubular necrosis mixed with changes due to acute rejection. Three grafts were lost due to technical major problems., Conclusions: Although we have observed some promising results, xenotransplant is a very difficult problem to solve in the long-term. A lot of research is still needed-.

Acquired cystic renal disease (A.C.R.D.) is a risk factor for the development of renal carcinoma in the patient's own kidney after renal transplant (R.T.), development of a primitive tumor in the renal graft is infrequent, but the presence of metastasis of an epithelial tumor is very rare. This is the second case reported in the literature of metastasis of an epithelial tumor in the renal graft and the first case described of renal cell carcinoma metastasis (R.C.C.) in the renal graft. This paper describes the case of a patient with a normally functioning renal transplant and A.C.R.D. who develops RCC in his own kidney, with metastasis in the renal graft.

Laparoscopic surgery requires a long training period of time in which the complexity of the training is increased. The technique presented in this paper has been developed in order to find an experimental model that allows us to improve the learning of the vascular suture. Our main goal was to evaluate this technique as an experimental model for the vascular anastomosis, not to obtain a functional autotransplant. In this regard, here we summarize our experience during the first two cases performed.

Pancreas Transplantation (PT) is the only available therapy today for diabetes that allows an insulin-independent euglycemic state with complete normalization of glycosilated haemoglobin levels. Survival of patient, pancreatic graft and renal graft is 93%, 86% and 90% respectively at one year and 90%, 84% and 85% at three years. The most accepted method for exocrine drainage in most centres where simultaneous pancreas-kidney transplantation is being performed is vesical drainage. In spite of the improvements achieved in graft and patient survival, it is evident that a most frequent use of this type of technique involves a greater number of urological complications (repeat infections, haematuria, fistulae or leakage, reflux pancreatitis, urethral stenosis and disruption, dehydration and acidosis, previous diabetic bladder) and the familiarization of the urologist with this type of disease in immunodepressed patients. This paper reviews the current situation and illustrates the general approach regimes in our Pancreas-Kidney Transplantation Unit with regard to each complication.

Pseudoaneurism in renal grafts is a well known complication of the percutaneous biopsy. Colour Doppler has been shown to be the choice technique for their diagnosis and subsequent control, the most effective treatment being embolization. This paper presents an unusual form of pseudoaneurism in terms of its size (up to 8 cm diameter) in a renal graft, following performance of a percutaneous biopsy with automatic needle. The findings of the colour Doppler study and the angiography are shown and discussed, as well as the treatment by embolization with metal spirals which achieved the stable, complete occlusion of the lesion after six months control.

Objective: Retrospective study of urological complications in our series of reno-pancreatic transplants., Material and Methods: Between February 1983 and May 1994 our group has conducted 93 RPT, 80 of which, mean age 36 +/- 6 years (24-54 years), are studied in this paper: 57 male and 23 female with an average time in dialysis of 20 +/- 15 months (0-84 months) and diabetes evolution of 21 +/- 5 years (11-37 years)., Results: Actuarial annual survival of patient, renal graft and pancreatic graft has been 85%, 79% and 74% respectively. Haematuria: 25% incidence, with graft pancreatitis etiology in 16 cases, rejection in 8 and urinary fistula in 6. Urinary infection: 85% incidence, symptomatic in 23 patients (29%) and asymptomatic in the remaining cases. Dysuria, urethritis and urethral stenosis: 14 patients, all male, most with both conditions associated. Reconversion of pancreatic exocrine secretion by intestinal route was performed in 7 patients. Urinary fistula: secondary to surgery in 9 cases and rejection in 4. Etiology of one case remained unknown. In 4 cases it was resolved with conservative treatment, and with surgical correction in 8. One patient required pancreatic transplantectomy and one patient died of AMI., Conclusions: Urological complication in RPT account for a significant morbidity, urinary fistula being the one with greater repercussion on the patient and pancreatic graft survival.

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.

Objective: The objective of this paper is to compare the hormonal changes and sexual activity between transplanted patients and patients in regular haemodialysis (HD)., Material and Methods: 130 patients, 98 RT carriers and 32 with CRF were evaluated with regard to the sexual function. The etiology of CRF is similar in both groups. All patients underwent hormonal determinations (FSH, LH, Prolactin, Testosterone, Oestradiol and PTH), complete serum testing and other diagnostic studies done selectively, 38 of 130 patients (14 in HD and 24 transplants) answered a personal questionnaire on sexual activity., Results: Oestradiol and prolactin levels are higher in the HD group compared to transplanted patients (p < 0.05). 70% of RT patients maintain their libido versus 35% of those in dialysis (p < 0.01). The former group refers good erection in 55% cases versus 21% of dialysis patients (p < 0.01). Intercourse frequency and degree of overall satisfaction is higher in the RT group (N.S.)., Conclusions: No significant differences were found in FSH, LH and testosterone levels. The normality of FSH levels may be a reflection of the integrity of the germinal line. 65% HD patients refer decreased or absent libido, to which the higher levels of prolactin and oestradiol found could contribute. No relationship was found between sexual function with the type of immunosuppression or the graft function.

Incidence of post-renal transplant (RT) lymphocele varies between 0.6% to 41% depending on the author. Therapeutical management of these entities is controversial. (Open or laparoscopic) surgical marsupialization of the peritoneal cavity, percutaneous drainage, and percutaneous sclerosis with povidone-iodine are all valid options to treat post-RT lymphocele. This paper presents two cases of symptomatic post-RT lymphocele not suitable for laparoscopic treatment, which were resolved by intracavitary instillation of Sodium Amidotrizoate 76%. The first case had been previously treated with povidone-iodine with no resolution, also maintaining a 500 ml/24h deficit. In the second case, instillation with Sodium Amidotrizoate 76% was considered first choice approach. In both instances the lymphocele deficit ceased with instillation intervals of 6 and 14 days, respectively. In brief, percutaneous sclerosis with Amidotrizoate can be a valid alternative for the treatment of post-RT lymphocele.

Severe vesicouretheral reflux sometimes causes terminal renal failure which then requires renal transplantation. In these patients it may be necessary to perform bilateral nephrectomy when associated to serious hypertension or urinary infections with a significant clinical impact. This paper presents the clinical picture of a patient with a corpse renal transplantation, due to terminal renal failure secondary to reflex nephropathy, in whom it was necessary to perform bilateral nephrectomy due to the uncommon urinary infections requiring hospitalization for treatment. The bilateral nephrectomy was done through transperitoneal laparoscopic approach, using seven points for trocars introduction. The procedure lasted 4 hours and the patients was discharged within 48 hours with no complications. Accumulate experience in the use of laparoscopy in urology has allowed this technique to be feasible. After designing the experimental model, our group has had the chance to accomplish laparoscopic nephrectomies in humans. We believe that this is the first case of bilateral nephrectomy conducted in our country using the laparoscopic approach.

Comparison of the effect of the Wisconsin University (WU) conservation solution in the graft's functional evolution and survival, and its cost-benefit relationship versus the Eurocollins (EC) solution with regard to cold ischaemia duration in a series of 142 consecutive adults renal transplantations from corpse donor, removed with beating heart. Of 142 kidneys, 92 (64.7%) were kept in WU and 50 (35.2%) in EC. Of the WU group, 62 (67.3%) kidneys were transplanted after a cold ischaemia of under 24 hours and 30 (32.6%) after cold ischaemia of more than 24 hours. In the EC group, 23 (46%) were kept in cold ischaemia for an interval shorter than or equal to 24 hours and 27 (54%) for more than 24 hours. Incidence of initial graft dysfunction (IGD) was greater in the EC groups (65% and 78%) versus the WU groups (39% and 50%), the difference being statistically significant (p). The graft function, as indicated by the creatinine levels was always better in the WU groups. There was a decreased need for complementary dialysis sessions, less days of oliguria and shorter hospitalization in the WU groups (p). There were no significant differences in the four series with regard to rejection episodes, cyclosporin-related nephrotoxicity, and vascular and urinary tract complications. All of which turn cost-effective the higher cost per litre of the WU versus the EC solution. Graft survival at 12 and 24 months was also significantly (p) higher for grafts kept in WU. This paper presents the results obtained in the analysis of our transplanted patients. In our experience, the WU solution allows better conservation of renal grafts, with less IGD and better graft survival at 12 and 24 months. These results turn cost-effective the higher cost per litre of the WU versus the EC solution.

The higher risk of developing malignant tumours in transplanted patients is a fact widely acknowledged over the last decade. This paper includes an analysis of our series and a review of the literature. Cancers developed by the transplanted patient or "de novo" cancers and, within this group skin and lip cancer (58%), are by far the most frequent ones. Their biological behaviour is, in general, more aggressive than similar ones in non-transplanted population. Also, different incidence rates and behaviour have been established depending on the immunosuppressive regime given to the patient. Most common pre-existing carcinoma was renal cancer (one third of cases). When these patients had been adequately treated before the transplant, the minimum disease-free interval that has to elapse to be included in a waiting list will depend on the type of tumour. Transferred tumours are the least frequent but more worrying ones due to both their clinical and legal implications. In view of the existing evidence, it is of particular relevance to insure the primitive nature of any CNS tumour as well as the absence of tumoral disease in young females who die of brain haemorrhage.

Lymphoceles are a complication of renal transplantation surgery. The source of this lymphatic collections is the lymph draining through the lymphatic vessels located in the transplanted kidney sinus and surrounding the iliac vessels of the receptor. The main etiological factor is the surgical technique used when dissecting these structures for graft placement. Several factors have been suggested as favouring their occurrence, acute rejection being highlighted as one. This paper reviews a series of 517 renal transplantations performed in our service, with a lymphocele incidence of 5.2% (28). Using a log regression model, the influence of age, sex, time in dialysis, presence of tubular acute necrosis in the graft following placement, acute rejection and immunological regime, for the appearance of lymphocele were analyzed. Age and lack of acute tubular necrosis were the only two factors selected by the model. Also, clinical signs and symptoms as well as therapy instituted were analyzed, emphasizing that puncture-drainage and instillation of iodine povidone was 100% effective.

Urinary tract complications continue to be a major cause of morbidity in renal transplant patients. This paper is a review of the urological complications developed in in 200 renal transplants performed in our service over a 10-year period, from January 1980 to December 1989, with a follow-up of at least 1 year. We include a total of 29.5% urological complications, subdivided in two sections each corresponding to a distinct period during which different procedures were used in the renal transplantation unit. The report includes an analysis of the complications' etiopathogenic, diagnostic and therapeutic factors.

This paper presents our experience with 237 primary renal cadaveric transplants and analyzes related factors to Initial Non-Function, its influence on graft and patient survival as well as the impact of cyclosporin A on graft survival. Our study shows better graft survival rates in patients treated with cyclosporin A and in patients with Immediate Initial Function.

The present paper analyzes the incidence of vascular complications and their treatment, in a series of 500 consecutive Heterotopical Kidney Transplants (KT), performed in our Service between January 1978 and December 1988. There was a total of 14 (2.8%) complications of which 8 (1.6%) correspond to renal artery stenosis. Of the 8 cases with renal artery stenosis, in 2 of them primary surgical treatment was indicated. The first one was a transplantectomy (TRX) and the second one reconstructive direct surgery. In the 6 remaining patients a Percutaneous Transluminal Angioplasty (PTA) was indicated. In three of these patients the stenosis resolved although one of them needed a second dilatation. In the last three there was: a thrombosis requiring TRX, a post dilatation anuria added to failure in the treatment of HT and which, finally, had to undergo surgery, and a third failure that could not be resolved by surgery and had to be subjected to graft nephrectomy. One of the patients in the surgical group died.

316 kidney transplants were carried out in the Ramón y Cajal Hospital between November 1979 and December 1988. The number of breakages was 7. In this paper we analyse the incidence of this complication as well as the etiopathogeny of the process, highlighting the relationship between the appearance of acute rejection, alterations in coagulation, and instrumental manoeuvres carried out on the graft, especially in the first days after transplant. The clinical pattern usually displayed was pain with swelling and pasting in the area of the implant, along with hypotension, oliguria and deterioration of kidney function. We underline the importance of echography as the follow-up method in the early detection of hematomas, perirenal collections, etc., which, together with the preceding clinical data, will orientate us towards an early diagnosis. We study the possible relationship of this complication with different factors, singling out the reduced frequency of appearance after the advent of cyclosporin and its use as an immunosuppressive drug. We advocate the conservation of the implant with three dimensional corsseting, provided this is feasible and the general conditions of the patient so permit.