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Background Renal allograft compartment syndrome (RACS) is an under recognized yet important complication of kidney transplantation that can lead to early graft dysfunction and loss. The use of mesh for prevention and treatment of RACS in very selective circumstances has been documented previously in small case reports. However, it is unknown whether patient and graft survival rates are similar in patients undergoing renal transplantation with mesh placement for the prevention or treatment of RACS. The purpose of our study was to examine the risk factors, indications, and outcomes of mesh hood fascial closure (MHFC) use in the context of RACS prevention. Methods All patients who underwent kidney transplantation in our center between 2009 and 2013 were reviewed. Patients with mesh placed at the time of initial transplantation and secondarily at the time of reoperation were identified. Patient characteristics, Doppler ultrasound findings, and overall patient and graft survival rates were compared among patients with and without mesh placement. Results Of 600 patients who received a kidney transplant, 134 patients underwent mesh placement, 123 primarily and 11 secondarily. Our overall 1-year patient and graft survival rates compared between those with and without MHFC were, respectively, 97.5% and 94.8% compared to 98.5% and 95.5% with P > .05. Our mesh removal rate was 6% (8/134), and the rate of mesh infection was 1.6% (2/134). Conclusions We are the first to report the outcomes of MHFC for the prevention of RACS in patients undergoing renal transplantation. We found that MHFC in select circumstances has minimal risks and similar overall patient and graft survival rates when mesh is not used. Prospective studies to better understand the pathophysiology of RACS will aid in determining objective clinical indications for MHFC to improve allograft survival. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study was to investigate whether kidney grafts from living related donors older than 50 years were safe for the donors and recipients in the long term. Methods: One hundred seven living related donor kidney transplantations were performed in our center from April 1994 to December 2007. No prisoners or organs from prisoners were used in the collection of these data. Donors were divided into 2 groups: >50 years of age (range, 51–78 years), designated as the study group, and ≤50 years of age (range, 21–50 years), designated as the control groups. The mean time of follow-up was 49 months (range, 12–180 months). Clinical data were compared, including donor serum creatinine (Scr) levels, glomerular filtration rates (GFR) before and after the procedures operative complications, and postoperative short-term and long-term recovery of renal function in recipients as well as their complications and recipient and kidney survivals. Results: All operations were successfully performed. Before the operation, the mean Scr and GFR were 82.16 ± 10.86 umol/L and 85.82 ± 6.26 mL/min, respectively, in the study group versus 78.66 ± 10.41 umol/L and 88.74 ± 9.44 mL/min, respectively, in the control group. There were no significant differences in mean Scr or GFR values between the groups at various preoperative or postoperative times (P > .05). No severe perioperative complications occurred, and no subsequent renal function failure was observed upon long-term follow-up of donors in the 2 groups. Comparisons of recipient age, gender ratio, duration on dialysis, HLA matches, cold/warm ischemia times, and immunosuppression therapy showed a correlations between the 2 groups. Mean Scr levels of recipients, which were compared from 1 week to 3 years following surgery, were slightly higher among the control than the study group, but the difference was not significant (P > .05). There were no significant differences between the study and control groups in 1-,3-,5-, and 8-year recipient/graft survival rates (P > .05). Conclusions: Long-term follow-up showed that transplantations using grafts from donors older than 50 years of age yielded similar results to those with younger donors. [Copyright &y& Elsevier]

Abstract: Objective: To establish an acute rejection model after kidney transplantation in the rat using a modified method of ureterovesical anastomosis. Methods: Thirty-nine Wistar rat donors, were transplanted into 70 male SD rats. Wistar rats (group 1; n = 18) underwent harvest of both kidneys, cold perfusion, and transplantation into 36 SD rats. Wistar rats (group 2; n = 18) underwent left kidney harvest, cold perfusion and transplantation into 18 SD rats. Groups 1 and 2 did not receive immunosuppression after transplantation. Six kidneys were harvested from 3 Wistar rats (group 3), were transplanted into 6 SD rats that were treated with CsA (5 mg/kg per day) postoperatively, and humanely killed at 21 days. There were 10 SD in sham operated rats (group 4). The renal allograft vein was end-to-end anastomosed to the recipient renal vein using an epidural catheter. The renal allograft was anastomosed end-to-side to the recipient abdominal aorta with an abdominal aortic flap. The renal allograft ureterovesical flap was directly inserted into the recipient bladder, and attached by 4–5 interrupted sutures. The recipient''s right kidney vessels were ligated at 3 days postoperatively. Results: The success rates were 91.7% and 88.9% in groups 1 and 2, respectively. Except for the time for removal of the renal allografts, the operative durations and warm ischemia times differed insignificantly between both groups (P > .05). Blood creatinine levels increased significantly after kidney transplantation in groups 1 and 2 compared with the sham operated and CsA-treated cohorts (P < .01), but insignificantly between groups 1 and 2 (P > .05). Conclusions: A dual renal allograft model was established in the rat using a modified ureterovesical anastomosis. The technique can be reproduced reliably, reducing costs and shorten using overall operative duration. [Copyright &y& Elsevier]