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ABSTRACTS
Year : 2020  |  Volume : 12  |  Issue : 5  |  Page : 19-20  

Abstract - SUA202 (Transplant)


Date of Web Publication9-Jun-2020

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DOI: 10.4103/0974-7796.278707

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How to cite this article:
. Abstract - SUA202 (Transplant) . Urol Ann 2020;12, Suppl S1:19-20

How to cite this URL:
. Abstract - SUA202 (Transplant) . Urol Ann [serial online] 2020 [cited 2021 Sep 21];12, Suppl S1:19-20. Available from: https://www.urologyannals.com/text.asp?2020/12/5/19/278707


   Successful management of post kidney transplantation urological complication in Al-Hada Armed Forces Hospital, Taif, KSA Top


Shady A. Soliman1,2, Tamer Daoud, Mohamed S. Al-Zahrani, Islam Elbalbouly2 Njlaa Al-Malki4

Departments of1Urology and Nephrology and3Chairman of Urology, Mansoura, Egypt, Al-Hada Armed Forces Hospitals, Taif, KSA,2Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

E-mail: [email protected]

Objectives: To report the incidence, diagnosis and management of urological complications in live- donor and cadaveric kidney transplant recipients in fast growing kidney transplant program.

Materials and Methods: Between September 2011 and October 2019, a total of 227 renal transplants (217 live-donor and 10 cadaveric) were performed . Urological complications were assessed regarding its incidence, mode of diagnosis and management; moreover patients and graft survival were compared between patients with and without complications .Diagnostic modalities included grey-scale and Doppler sonography, non-contrast spiral computed tomography ,percutaneous aspiration of a collections an percutaneous nephrostomy placement.

Results: There were 7 complications (3.1%) including two early; urinary leakage in one patient and symptomatic lymphocele in another. Five late complications; three ureteric stricture and two urinary stones. Urinary leakage occurred in a post-cadaveric transplant 10 days after surgery and managed by urethral catheter placement and percutaneous tube drain. One symptomatic lymphocele 3 weeks pot-transplant was successfully managed by percutaneous tube drain fixation and injection sclerotherapy. Three patients developed ureteral stricture (one cadaveric/ two live donor) at 12, 14 and 84 months presented with rising of creatinine and new onset hydronephrosis , percutaneous nephrostomy and antegrade pyelogram was mainstay for diagnosis , two were successfully managed with endoscopic meatotomy while the third required ureteroneocystostomy after failure of endoscopic management. One patient had 2 cm ureteric stone was successfully managed by Ureteroscopy, laser disintegration and stenting, another one with ureteric stone responded well to ESWL with complete disintegration and clearance. There was no statistically significant difference in graft survival in patients with and without urological complications.

Conclusions: Our results match the international figures. Endourological management has good results and should be tried first. Meticulous long term follow up is mandatory to pick up any late complications. Urological complications do not adversely affect graft survival.


   Critical analysis of vascular complications in kidney transplant reciepients: Al-Hada armed forces hospital new experience Top


Shady A. Soliman1,2, Tamer Daoud2, Mohamed S. Al-Zahrani3, Islam Elbalbouly2, Njlaa Al-Malki1

1Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt, Departments of2Urology and3Urology, Al-Hada Armed Forces Hospitals, Taif, KSA

E-mail: [email protected]

Objectives: To determine the incidence, analyze the causes, and describe the diagnosis and management of vascular complications in live- donor and cadaveric kidney transplant recipients in fast growing kidney transplant program.

Materials and Methods: Between January 2011 and November 2019, a total of 238 renal transplants (228 live-donor and 10 cadaveric) were performed. Vascular complications were calculated, causes were analyzed, incidence was enumerated, mode of diagnosis and management; moreover patients and graft survival were compared between patients with and without vascular complications .Diagnostic modalities included grey-scale and Doppler sonography, non-contrast spiral computed tomography.

Results: There were 6 complications (2.5%) included 3 vascular thromboses (1.25%) and hemorrhage in 3 (1.25%). Vascular thrombosis occurred in two cadaveric, 2 days post-transplant (patient with thrombosed IVC) and 7 days (border-line kidney with extended criteria donor) and one living donor due to extensive venous injury in laparoscopic donor nephrectomy. All ended with graft nephrectomy. Hemorrhage occurred in 3 patients; ABO incompatible transplant due to medical cause; female transplant with bleeding diathesis. Managed by surgery, the source of bleeding could not be identified in these two and parietal bleeding in the third patient and was secured. Graft survival is significantly lower in patients with vascular complications.

Conclusions: Vascular thrombosis significantly affects graft survival. Selection of cadaveric kidney should be weighted. Post-operative close monitor is mandatory to pick up and proper manage vascular complication.


   Malignancy after kidney transplantation; Tabuk experience Top


M. Elbahnasawy, H. Yehia, A. Alali, A. Elbahnassawi1, A. Albalawi, Y. Osman

Department of Surgery, Urology Division, King Salman Armed Forces Hospital,1Department of Nephrology, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

E-mail: [email protected]

Introduction and Objectives: In kidney transplant recipients, the incidence of cancer is generally increased 2 to 4 fold compared with the general population. Nonmelanoma skin cancer is the most common malignancy, followed by post-transplant lympho-proliferative disorder and solid organ tumors. Immunosuppression plays a central role in pathogenesis in addition to other transplant-related and traditional risk factors as viral infections. Urinary and kidney malignancies may be linked to ESRD. Malignancies are diagnosed at younger age and at higher stages compared to patients without transplantation, and are associated with worse outcomes.Our objective is to retrospectively analyze the prevalence of malignancy among cases of kidney transplant in our hospital.

Materials and Methods: In this retrospective study ,385 cases of renal transplantation (RT) who has follow up in our renal and transplantation unit , were analyzed depending on database from 2000 to 2018. Patients records were reviewed for the duration of pre-RT hemodialysis, type of kidney donor (cadaveric or live donor-related or unrelated), immunosuppression protocol, post transplantation time until developing malignancy, type of diagnosed malignancy and management of each malignancy.

Results: During the study period a total of 9 cases (2.34%) of post-RT malignancy has been diagnosed Mean age at diagnosis was 53.6 years while mean post-transplantation duration before malignancy was 10.5 years. Two cases received unrelated kidney donors, one cadaveric kidney, and one had second kidney transplant. Skin cancer was seen in 4 cases, while genitourinary malignancy was diagnosed in 3 cases(one seminoma ,one muscle invasive bladder cancer and one graft RCC) and 2 cases developped thyroid carcinoma. Two cases ( 22.2%) died of malignancy including a case of advanced graft renal cell carcinoma (RCC), who died of inoperable malignancy.

Conclusions: The risk of developing post renal transplantation malignancy is higher than normal population. Skin cancers are the more prevalent malignancy. Lympho-proliferative malignancies were not seen in our RTR. Patients receiving kidneys of unrelated donor, cadaver, or re-transplant are at higher risk, possibly due to more aggressive immunosuppressive protocols. Aggressive behavior of these malignancies highlights the necessity of long life follow up, putting a high index of malignancy suspicion for early diagnosis. Modification of immunosuppressive protocol is advised in such malignant cases.




 

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