RESUMO
INTRODUCTION: One of the frequent complications suffered by patients with chronic renal failure is the lack of vascular access due to venous thrombosis. This means that the transplant surgeon must have a detailed knowledge of the intra-abdominal venous system, and other alternative surgeries, at the time of performing the renal graft implant, in order to ensure a good venous drainage. PRESENTATION OF THE CASE: This article provides a case report regarding a patient with no vascular access and with surgical difficulties at the time of the kidney transplant, in whom a renal-portal venous drainage was performed with very good outcome. DISCUSION: Renal-portal venous drainage is a way to performe kidney transplant with good outcome. In Fundación Valle del Lili we have overcome the lack of vascular access in patients that need a renal transplant by new surgical technics that improve the patients quality of life and survival. CONCLUSION: We can conclude that new surgical alternatives exist for those patients with chronic renal failure that have no vascular access. These patients are a priority for kidney transplants and the surgeon must take in to account the need for a new surgical assessment.
RESUMO
Tipo de estudio: retrospectivo, analítico, longitudinal. Objetivos: evaluar el uso del micofenolato de mofetil (MMF) en el tratamiento inmunosupresor en pacientes con transplante renal y glomerulopatías primarias. Materiales y métodos: se realizó un estudio retrospectivo que evaluó a 19 pacientes de 23-61 años: 14 con transplante renal (TR) y 5 con glomerulopatías primarias (GP). Todos los pacientes con TR recibieron: ciclosporina A (CsA) + prednisona (P), de los cuales 10 recibieron adicionalmente azatriopina (AZA) y 4 MMF. Las pacientes con GP recibieron MMF exclusivamente. Ambos grupos fueron seguidos por 12 meses, tiempo durante el cual se evaluó la función renal y efectos adversos. Resultados: el valor del injerto mejoró significativamente en aquellos pacientes tratados con esquemas que incluían MMF. Los valores promedio de creatinina sérica a los 12 meses fueron de 1.5 0.4 mg/dL grupo MMF vs. 1.7 0.2 mg/dL AZA. Los efectos secundarios se presentaron en un 40% en el grupo AZA y en un 25 % en el grupo MMF. Algunos pacientes con GP mejoraron su función renal. Conclusiones: en aquellos pacientes que recibieron tratamiento inmunosupresor con MMF, la función renal del injerto mejoró al ser comparado con el esquema que incluía AZA. En las GP los resultados fueron poco concluyentes.
Objective: Evaluate the usefulness of mycophenolate mofetil (MMF) as an immunosuppressive therapy for patients with renal transplants and primary glomerular disease. Materials and methods: This was a retrospective study which evaluated a total of 19 patients aged 23-61: 14 with renal transplants (RT) and 5 with primary glomerular disease (PGD). All patients with RT received: cyclosporine A (CsA) + prednisone (P), 10 of those additionally received azathioprine (AZA) and 4 MMF. Patients with PGD received only MMF. Both groups were followed up for 12 months during which renal function and adverse effects were evaluated. Results: The value of the graft was significantly improved among those patients who received regimens with MMF. Average creatinine serum values at 12-month follow-up were 1.5 0.4 mg/dL in MMF group vs. 1.7 0.2 mg/dL in AZA group. Adverse effects presented in 40% of those treated with regimens including AZA and in 25% of those including MMF. Some patients with PGD improved their renal function. Conclusions: Renal graft function improved among patients receiving immunosuppressive regimens that included MMF when compared to those regimens that included AZA. Results among patients with PGD were inconclusive.
Assuntos
Masculino , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Glomerulonefrite , Terapia de Imunossupressão , Transplante de Rim , Azatioprina , Ciclosporina , Glomerulonefrite Membranoproliferativa , Glomerulonefrite Membranosa , Imunossupressores , PrednisonaRESUMO
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
Se realizaron 208 biopsias de riñón en 197 trasplantes renales efectuados entre el 2000 y el 2004, 31,8 % correspondieron a donantes vivos y el resto procedieron de donantes cadáveres. Se observó rechazo hiperagudo o agudo acelerado en 6 casos (3,1 %), sospechoso de rechazo en 15 casos (7,9 %), el rechazo agudo tipo 1 resultó ser el más frecuente, fue encontrado en 20 casos (10,5 %), se diagnosticaron 16 casos de rechazo agudo tipos 2 y 3 (8,3 %), todos los pacientes del tipo 3 perdieron la función del injerto, la nefropatía crónica esclerosante se vio en 42 casos (22,1 %). También se analizaron cambios no considerados por rechazo donde la necrosis tubular aguda fue la más frecuente y se encontró en 71 pacientes para un 37,5 %.
208 kidney biopsies were performed in 197 renal transplants between 2000 and 2004. 31.8 % corresponded to living donors and the rest were from dead donors. Hyperacute or acute accelerated rejection was observed in 6 cases (3.1 %), and suspicion of rejection in 15 cases (7.9 %). The type 1 acute rejection was the most frequent. It was found in 20 cases (10.5 %). 16 cases of type 2 and 3 acute rejection (8.3 %) were diagnosed. All the type 3 patients lost the graft function. Sclerosing chronic nephropathy was detected in 42 cases (22.1 %). Changes that were not considered as rejection were also analyzed. The acute tubular necrosis was the most common in them, since it was found in 71 patients, accounting for 37.5 %.