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Background: In the experience of other authors, double kidney transplant have a higher complication rate (30%) if compared with single renal graft. In personal experience the use of small calibre ureteral stents with antireflux valve can reduce this complication rate., Methods: From November 1999 to April 2001, at the A.S.O. S. Giovanni Battista in Turin, we performed 29 double kidney transplantations with the application of small calibre stents in 20 male and 9 female patients, aged 50-74 years. The uretero-neocystostomies were carried out according to Lich-Gregoire technique, and the JJ stents used were pediatric ones, 12 cm long and 4.8 Ch, with antireflux valve., Results: We complained only 2 urological complications out of 58 anastomoses (distal unilateral ureteral necrosis in 1 case and total ureteral necrosis in the other)., Conclusions: Complication rate is lower than in the literature: the authors suggest that the use of small calibre JJ stents can keep the complication rate low in double kidney transplant.

Background: We report our experience in transplantation proceedings with the use of small caliber JJ ureteral stent with antireflux valve during uretero-vesical anastomosis., Methods: During renal transplantations we usually perform an uretero-cystoneostomy with antireflux technique according to Lich Gregoir. In the past we used to intubate the uretero-vesical anastomosis only in particular cases; since April 1998 we performed 112 single and 8 double transplants and in all cases we positioned a 12 cm long paediatric 4.8 Ch JJ ureteral stent with antireflux valve, in order to reduce urologic complications. The vesical catheter was usually removed in 6o-7o day and the ureteral stent 40-60 days after transplantation., Results: We have performed 129 uretero-vesical anastomoses and we complained only one case of early dehiscence of the anastomosis (unilateral in a double transplant) and two cases of late stents' displacement. We noticed no stenosis of the anastomosis and no dysfunction in urine outflow from the upper urinary ways., Conclusions: The routinary use of paediatric JJ ureteral stents with antireflux valve was decisive in drastically reducing early urologic complications after renal transplantation. Furthermore, the risk of vesico-ureteral reflux is almost completely reduced, thanks to the technique adopted for the anastomosis which allows a physiologic-like antireflux mechanism, to the presence of the antireflux valve and to the early recovery of the physiologic ureteral peristalsis, which is promoted by the small calibre of the stent. These factors lead to a faster recovery of the renal function, with excellent results from the nephrologic and urologic points of view.

Background: To evaluate survival rate, follow-up and renal function in patients treated with "nephron-sparing" approach due to cancer in a transplanted kidney., Methods: During the 18 years' activity of our Transplantation Centre 3 renal carcinomas in transplanted kidneys (0.24%) have been found. Diagnoses were made in one case during transplantation procedures and, in the remaining two, 1 month and 10 years after. All tumours were unifocal, small (10, 12 and 18 mm of diameter), capsulated and low stage (T1). The resection of the mass ("nephron-sparing" surgery) and of a layer (1 cm thick) of the tissue surrounding the tumour was performed. The histological exam showed in all cases low grade (G2) renal cell carcinoma and negative surgical margins., Results: 138, 94 and 15 months after transplant all patients are alive, without disease recurrence and with good renal function. In all cases the doses of immune-suppressive therapy were reduced., Conclusions: Renal cancer in transplanted kidneys is generally treated with nephrectomy. On the contrary, we decided to apply the same criteria which are accepted for the treatment of renal neoplasms in general and then to perform a "nephron-sparing" surgery when the tumour is small, capsulated and with negative surgical margins at the intraoperative histological exam. In personal experience good results from the oncologic and nephrologic point of view have been accomplished.