Our video shows the laparoscopic drainage of a big lymphocele responsible of kidney graft obstructive failure. Apart from the laparoscopic access, the technique is similar to open surgery. An ellipsoid peritoneal window (approximately 6 x 3 cm) is created with scissors and electrocautery. The lymphocele is entered and completely drained. A few adhesions are divided. To keep the window open, we secured its anterior margin with clips. Postoperative period was uneventful, with immediate improvement of the kidney graft function. After 4 months, there was no lymphocele seen on computerized tomography.
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Clin Transplant
February 2025
Department of Transplant Nephrology, Transplant Surgery Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Calcineurin inhibitors have been the choice for maintenance immunosuppression (IS) in kidney transplant recipients (KTR), but they are associated with nephrotoxicity and metabolic side effects. We aim to compare the long-term outcomes of KTR on belatacept (bela) versus tacrolimus (tac) IS, in all KTRs and various subgroups. Using the UNOS-STAR files, we identified adult first-KTR from 2010 to 2022.
View Article and Find Full Text PDFXenotransplantation
January 2025
Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
Background: The removal of preformed antibodies with cleaving enzyme like IdeS (Imlifidase) has demonstrated therapeutic potential in organ transplantation for sensitized recipients. However, preformed xenoreactive antibodies (XAbs) against porcine glycans are predominantly IgM and considered detrimental in pig-to-human xenotransplantation.
Methods: Recombinant IceM, an endopeptidase cleaving IgM, was generated in Escherichia coli.
J Am Coll Surg
January 2025
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
Background: Obesity is a significant barrier to kidney transplantation for patients with end-stage renal disease (ESRD). We aimed to evaluate the long-term impact of metabolic and bariatric surgery (MBS) on kidney transplantation access and outcomes in individuals with obesity and ESRD patients.
Study Design: A retrospective cohort study using data from 64 US healthcare organizations included 132,989 individuals with obesity (BMI ≥30kg/m²) and ESRD requiring dialysis, of whom 6,263 (4.
Curr Opin Organ Transplant
January 2025
Department of Kinesiology and Health Sciences.
Purpose Of Review: Patients that present with a physical frail phenotype have a higher risk of poor kidney transplant outcomes and are therefore less likely to be wait listed for a transplant. The physical frailty phonotype is more prevalent in older adults >65years with chronic and end stage kidney disease, thus partly contributing to inequitable access to transplant. Frailty can potentially be reversed by prehabilitation.
View Article and Find Full Text PDFTranspl Int
January 2025
Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Highly sensitized (HS) patients in need of kidney transplantation (KTx) typically spend a longer time waiting for compatible kidneys, are unlikely to receive an organ offer, and are at increased risk of antibody-mediated rejection (AMR). Desensitization using imlifidase, which is more rapid and removes total body immunoglobulin G (IgG) to a greater extent than other methods, enables transplantation to occur between HLA-incompatible (HLAi) donor-recipient pairs and allows patients to have greater access to KTx. However, when the project was launched there was limited data and clinical experience with desensitization in general and with imlifidase specifically.
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