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Laparoscopic living donor nephrectomy（LDN）has become a standard procedure, and transperitoneal LDN is now performed at many centers. Since 2001, we have been developing a retroperitoneoscopic living donor nephrectomy（RPLDN）technique that allows LDN to be performed by a direct retroperitoneal approach that does not interfere with the abdominal organs. In this study, we examined the operating time, blood loss, total and warm ischemic times（TIT, WIT）, length of stay, number and length of renal arteries and vessels, graft function, and complications in 54 kidney donors（19 men, 35 women；mean age 57.1±11.8 years）who underwent living donor kidney transplantation with allografts obtained by RPLDN. Mean follow-up was 16.8 months. Donor nephrectomy was successful in all patients. Fifteen kidneys had ≥ 2 renal arteries. The complication rate was 5.6％. There were no serious complications. Ureteral complications occurred in four recipients, who were successfully treated by retrograde ureteral stent placement. Mean TIT was 87.7 min and mean WIT was 4.7 min. Mean serum creatinine levels in recipients were 3.5, l.5, and 1.4 mg/dL on postoperative days 1, 7, and 14, respectively. Slow graft function was noted in four cases（7.4％）, which normalized within 2 weeks of surgery. One-year donor survival was 100％ and 1-year graft survival was 98.1％. All RPLDNs were well tolerated and the impact on recipient graft function was excellent. RPLDN could be an option for LDN.

Background To evaluate the role of the oral glucose tolerance test (OGTT) before transplantation and to examine the risk factors for new-onset diabetes after transplantation (NODAT) during long-term follow-up of renal transplant recipients receiving FK-based therapy. Methods The study evaluated 378 patients pre-transplantation using the OGTT and assigned them to one of three groups: Group 1, normal pattern; Group 2, impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) pattern (IFG/IGT); and Group 3, DM pattern. Results Although the incidence of NODAT was higher in Group 3 than in groups 1 and 2, no significant difference was found between the three groups with regard to graft survival during long-term follow-up. Multivariate analysis showed that only a family history of diabetes was a significant factor determining NODAT progression. Conclusions Impaired glucose tolerance appears to be a threshold influencing NODAT; however, it was not a significant factor in graft survival. Careful monitoring and management based on the result of the pre-transplantation OGTT appear to prevent the deterioration of impaired glucose tolerance in renal transplant recipients receiving FK-based therapy, even when a pre-operative OGTT shows impaired glycemic control.

Hemolysis may occur after organ transplantation. In most cases, hemolysis is drug-related, such as to cyclosporin, etc. However, it is important to consider graft-versus-host antibody formation as one of the causes of hemolysis. We evaluated the effect of local graft irradiation as a method of preventing hemolysis arising from ABO antibody formation after ABO-mismatched renal transplantations. The participants in this study were 44 patients who had undergone ABO-mismatched renal transplantation. Of these patients, 23 were subjected to postoperative local irradiation, and 21 were not. We examined the characteristics of anti-blood-type antibodies, and we also compared the frequency of the development of antibody formation and hemolysis development between the groups. The development rates of anti-ABO-antibody formation and hemolysis were significantly higher in the patients without local irradiation (15/21, 71%; 6/21, 29%) than in those with local irradiation (1/23, 4%; 0/23, 0%). The elevated antibodies mainly belonged to the IgG class, not the IgM class. The hemolysis- and antibody formation observed in the patients originally without postoperative local irradiation was dramatically improved by graft irradiation. Local graft irradiation after ABO-mismatched renal transplantations may be needed to prevent the formation of anti-ABO antibodies and to impede the development of hemolysis.