Authors:László Piros, P. Á. Deák, G. Dallos, Zs. Máthé and A. Doros
Ureteric complications following renal transplantation are well known to cause significant morbidity and compromised graft survival. The necrosis of a major part of the ureter could be a highly detrimental situation, and hardly solvable complication, that poses great challenges. Herein we are presenting a case report to introduce a possible surgical solution following repeated ineffective radiological interventions, in a patient with ureteric necrosis that appeared 3 months after cadaveric kidney transplantation. We transplanted the right kidney to the right iliac fossa performing end-to-side vascular anastomoses and end-to-side uretero-ureterostomy. His clinical course was uneventful during 3 months, when he presented a mild borderline acute cellular rejection together with dilatation of the pyelon. Percutaneous nephrostomy was performed by interventional radiologist. During further radiologic interventions the stenosis was not permeable. We finally made up our minds for surgical solution. We found a totally necrotized graftureter. During a second operation we performed a right nephrectomy, transsecting the pyelon. After mobilization of the transplanted kidney approaching and identifying the pyelon, a large pyelopyelar anastomosis was performed with stenting. The postoperative follow-up showed excellent urine flow from the kidney to the bladder, then the TRD was removed. Surgery had to be considered only if minimally invasive procedures are infeasible or ineffective. A regimen of reconstructive methods are well-known, but all cases have to be evaluated individually. If the native kidneys can be removed, their pyelons and entire ureters should be used for reconstruction.
Authors:Veronika Kozma, Gy. Végső, P. Á. Deák, E. Hartmann, A. Németh, Sz. Török, R. Langer and A. Doros
Kidney neoplasms can occur after kidney transplantation in low percentage. In this report we delineate a rare case of neoplasm in the transplanted kidney detected on screening ultrasonographic examination. Due to the intercalyceal location of the tumor percutaneous radiofrequency ablation was planned with continuous cooling the collecting system avoiding the thermal damage. To the best of our knowledge this method has never been reported applying in transplanted kidney. The two-month CT follow-up verified no residual tumor and the kidney function remained in normal range during this period. These facts imply that the method can be safely applied.
Authors:A. Doros, B. Nemes, Z. Máthé, A. Németh, E. Hartmann, Á. P. Deák, Zs. F. Lénárd, D. Görög, I. Fehérvári, Zs. Gerlei, J. Fazakas, Sz. Tóth and L. Kóbori
Hepatic artery complication represents recognized sequel of liver transplantation that carries significant morbidity and mortality. Besides retransplantation, hepatic artery recanalization is provided surgically, or by percutaneous angioplasty and stent placement. This study provides an analysis of a single center experience comparing surgical and interventional treatments in cases of early hepatic artery complications.
In this retrospective single center study, 25 of 365 liver transplant recipients were enrolled who developed early hepatic artery complication after transplantation. Percutaneous intervention was performed in 10 cases, while surgical therapy in 15 cases. Mean follow-up time was not different between the groups (505±377 vs. 706±940 days, respectively).
6 patients in the Intervention Group and 10 patients in the Surgery Group are alive. The retransplantation rate (1 and 3) was lower after interventional procedures, while the development of biliary complications was higher. The mortality rate was higher after operative treatment (2 and 5).
Interventional therapy is a feasible and safe technique for treatment of early hepatic artery complication after transplantation. Being less invasive it is an invaluable alternative treatment having results comparable to surgical methods.
Authors:E. Hartmann, A. Németh, Gy. Juharosi, Zs. Lénárd, P. Á. Deák, V. Kozma, P. Nagy, Zs. Gerlei, I. Fehérvári, B. Nemes, D. Görög, J. Fazakas, L. Kóbori and A. Doros
Hepatocellular carcinoma, which has developed in liver cirrhosis is a disease where liver transplantation can provide a cure both for the tumour and the underlying liver damage. However, patients can only be transplanted when the tumour number and size do not exceed the Milan criteria. Tumour ablation methods — such as radiofrequency ablation — can provide a chance to make the patient eligible for transplantation. Among the 416 Hungarian liver transplanted patients there are 6 who had received different types of ablative therapy as bridging therapy in different institutions. On the basis of analysis of the patients' data we created a guideline for the treatment of cirrhotic patients with hepatocellular carcinoma with the aim of developing a uniform Hungarian approach.