RESUMO
Renal graft rupture (RGR) is a life-threatening complication of kidney transplantation (KT), frequently associated with rejection and acute tubular necrosis. RGR repair with the use of suture, and corsetage with various materials (including synthetic glue, polyglactin absorbable hemostatic mesh, and lyophilized human dura), is indicated in non-severe cases. However, the employment of non-absorbable synthetic mesh had not been previously reported. Here, a case of a KT from cadaveric donor with RGR associated with acute rejection is reported. The graft was salvaged with the employment of a non-absorbable polypropylene mesh. Six months after KT, the patient remains asymptomatic with normal renal function. To the best of our knowledge, this is the first report of the use of a non-absorbable polypropylene mesh to repair a RGR. In a setting in which economical restrictions are important, the use of non-absorbable synthetic mesh may represent a good option of treatment.
Assuntos
Nefropatias/cirurgia , Transplante de Rim , Complicações Pós-Operatórias/cirurgia , Telas Cirúrgicas , Transplante/efeitos adversos , Adulto , Soro Antilinfocitário/uso terapêutico , Esponja de Gelatina Absorvível , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/prevenção & controle , Hematoma/etiologia , Humanos , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Masculino , Metilprednisolona/uso terapêutico , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Hemorragia Pós-Operatória/etiologia , Prednisona/uso terapêutico , Ruptura Espontânea/cirurgia , Linfócitos T , Tacrolimo/uso terapêutico , Transplante/patologiaRESUMO
Renal graft rupture (RGR) is a life-threatening complication of kidney transplantation (KT), frequently associated with rejection and acute tubular necrosis. RGR repair with the use of suture, and corsetage with various materials (including synthetic glue, polyglactin absorbable hemostatic mesh, and lyophilized human dura), is indicated in non-severe cases. However, the employment of non-absorbable synthetic mesh had not been previously reported. Here, a case of a KT from cadaveric donor with RGR associated with acute rejection is reported. The graft was salvaged with the employment of a non-absorbable polypropylene mesh. Six months after KT, the patient remains asymptomatic with normal renal function. To the best of our knowledge, this is the first report of the use of a non-absorbable polypropylene mesh to repair a RGR. In a setting in which economical restrictions are important, the use of non-absorbable synthetic mesh may represent a good option of treatment.
La ruptura del injerto renal (RIR) es una complicación del trasplante renal (TR) que amenaza la vida, y frecuentemente está asociada a rechazo y necrosis tubular aguda. La reparación de la RIR con el uso de sutura y ferulización con varios materiales (incluyendo pegamento sintético, mallas hemostáticas absorbibles de poliglactina y duramadre liofilizada humana) está indicada en los casos no graves. Sin embargo, el empleo de mallas no absorbibles no había sido informado previamente. Aquí se informa el caso de un TR proveniente de donador cadavérico con RIR asociada a rechazo agudo. El injerto fue rescatado con el empleo de una malla no absorbible de polipropileno. Seis meses después del TR el paciente se encuentra asintomático con función renal normal. Hasta donde tenemos conocimiento, éste es el primer informe del uso de una malla no absorbible de polipropileno para reparar una RIR. En un medio con importantes restricciones económicas, el uso de mallas sintéticas no absorbibles puede representar una buena opción de tratamiento.
Assuntos
Adulto , Humanos , Masculino , Transplante de Rim , Nefropatias/cirurgia , Complicações Pós-Operatórias/cirurgia , Telas Cirúrgicas , Transplante/efeitos adversos , Soro Antilinfocitário/uso terapêutico , Esponja de Gelatina Absorvível , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/prevenção & controle , Hematoma/etiologia , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Metilprednisolona/uso terapêutico , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Hemorragia Pós-Operatória/etiologia , Prednisona/uso terapêutico , Ruptura Espontânea/cirurgia , Linfócitos T , Tacrolimo/uso terapêutico , Transplante/patologiaRESUMO
A total of 1,356 kidney transplants has been performed in the Hospital de Especialidades del Centro Médico Nacional de Occidente, IMSS, in Guadalajara Mexico, including 935 in the past 8 years. This represents an important increase of this activity in our country. Of the total transplants, 1,218 (90%) were from living donors and only 138 (10%) were from cadaveric donors, a number that we hope to increase. Most recipients were young adults, with an average age of 31 years old. The overall one-year graft and patient survival rates for living-donor kidney recipients were 90% and 82%, and for cadaveric kidney recipients they were 80% and 70%, respectively. Acute rejections occurred in 17% and chronic allograft nephropathy was diagnosed in 7% of our kidney transplant recipients. The main cause of patient death was infection, frequently invasive CMV. Cardiovascular complications were a relatively infrequent cause of death as has been seen in other international series. Hepatitis B and C have been widley studied. Hepatitis C is the most prevalent viral infection in our population. Both living and cadaveric donors in our series were young, which may explain the good results. We have had very few complications among living donors and no mortality. Two donors developed chronic renal insufficiency after the kidney donation (0.001%). This excellent safety record reflects the experience of our team. We hope to increase the number of cadaveric transplant donors with the renewed interest in enlarging the transplantation programs in Mexico while maintaining our high percentage of living donors in order to benefit more patients.
Assuntos
Transplante de Rim , Adolescente , Adulto , Doença Crônica , Feminino , Hepatite B/complicações , Hepatite B/epidemiologia , Hepatite C/complicações , Hepatite C/epidemiologia , Humanos , Nefropatias/complicações , Nefropatias/cirurgia , Falência Renal Crônica/complicações , Transplante de Rim/estatística & dados numéricos , Hepatopatias/etiologia , Doadores Vivos , Masculino , México , Pessoa de Meia-Idade , Prevalência , Doadores de TecidosRESUMO
BACKGROUND/AIM: There is not enough information regarding risk factors for renal graft loss in Mexico and Latin America. The aim of this study was to analyze risk factors associated with graft loss in our renal transplant (RT) population. METHODS: Clinical records of 326 patients with a first RT performed between August/76 and June/99 were reviewed. Clinical and laboratory variables were recorded, as well as the final patient and renal function status. STATISTICAL ANALYSIS: Survival analysis by Kaplan-Meier method; mortality risk by multivariate Cox's proportional hazard model. RESULTS: At the end of the study, 275 patients were alive, 30 were dead, 21 lost to follow-up; 65 patients (20%) had reinitiated dialysis. Patient survival at 1, 3, 5, 8, and 10 years was 92%, 86%, 81%, 77%, and 77%, respectively. Graft survival at 1, 3, 5, 8, and 10 years was 87%, 73%, 64%, 50%, and 47%, respectively. In the univariate analysis, the following were significantly associated (p < 0.05) with graft loss: acute rejection episodes, cadaveric donors, and HLA haplotype mismatches. In the multivariate analysis, only acute rejection (RR 2.12, p = 0.002) and a lower HLA haplotype matching (RR 0.37, p = 0.002) predicted graft loss. CONCLUSIONS: In Mexican population, graft survival was similar to the reported in developed countries. The main risk factors for long-term graft failure were acute rejection and HLA haplotype mismatching.