Troubleshooting Complex Vascular Cases in the Kidney Transplant Recipient: Vascular Anomalies, Challenging Vessel Diseases, and Procedural Disasters
| Autor: | Francisco Javier Burgos, Javier Lorca, Ana Dominguez, Vital Hevia, Sara Álvarez, Victoria Gómez, Marta Santiago, Victor Diez, Manuel Hevia, Cristina Gordaliza |
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| Rok vydání: | 2020 |
| Předmět: |
Reoperation
Nephrology medicine.medical_specialty Vascular Malformations Urology medicine.medical_treatment Urinary system Iatrogenic Disease Population 030232 urology & nephrology Transplants Kidney Prosthesis Kidney transplant 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Vascular Diseases Intraoperative Complications education Dialysis Peripheral Vascular Diseases education.field_of_study business.industry Vascular disease Anastomosis Surgical General Medicine Vascular System Injuries medicine.disease Kidney Transplantation Surgery Kidney transplant recipient Treatment Outcome Urogenital Abnormalities 030220 oncology & carcinogenesis Kidney Failure Chronic business |
| Zdroj: | Current Urology Reports. 21 |
| ISSN: | 1534-6285 1527-2737 |
| Popis: | To update the most relevant literature regarding complex cases during kidney transplant setting that recipient presents by himself, especially during implantation surgery due to vascular diseases and/or urinary tract anomalies. Increasing age of donors and recipients is leading to an increased complexity of kidney transplant implantation surgery. In addition, the high peripheral vascular disease prevalence worldwide increases difficulty of surgery and decreases long-term outcomes as well. Moreover, it also increases transplant morbidity and mortality, both overall and cardiovascular, and finally clearly decreases graft survival. However, dialysis alternative has even worse outcomes in terms of mortality, with a proportional risk of death 2.66 higher compared with transplanted patients. Aorto-iliac prosthesis and 3rd and 4th transplants in occupied iliac fossae do also represent a challenging situation with a clearly increased morbidity and mortality. In some of those particular conditions, orthotopic kidney transplant technique is an alternative with good functional and survival outcomes, but not exempt of complications. Kidney transplant in vascular complex recipients has worse outcomes compared with conventional non-risky population. It remains a challenging surgical and medical procedure with higher morbidity and mortality, and decreased graft survival. However, dialysis mortality is still even greater and a transplant attempt might be justified. Orthotopic kidney transplant technique might play a role in selected patients with aorto-iliac unworkable segments or even in patients with special urinary tract conditions. |
| Databáze: | OpenAIRE |
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