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renal warm ischemia

Debojit Gogoi, Dilip Kumar Pal, Malay K Bera
Laparoscopic donor nephrectomy (LDN) can be performed via either transperitoneal or retroperitoneal approach. Very few studies have been carried out till now, comparing immunologic and inflammatory responses in donors after these two approaches. This is a prospective observational study. Selection of approach was decided by the operating surgeon. All patients underwent peripheral venous blood sampling preoperatively and 24 h postoperatively for the measurement of C-reactive protein (CRP), interleukein-6 (IL-6), total leukocyte count (TLC), blood urea nitrogen (BUN), and serum creatinine (SCr)...
September 2016: Saudi Journal of Kidney Diseases and Transplantation
Xiaobing Ju, Pu Li, Pengfei Shao, Qiang Lv, Zengjun Wang, Chao Qin, Jie Li
OBJECTIVE: To assess the feasibility of retroperitoneal laparoscopic nephrectomy combined with bench surgery and autotransplantation in treating complex renal tumor. PATIENTS AND METHODS: Six patients with complex renal tumor were seen in our institution between 2010 and 2014. Three patients with bilateral renal cell carcinoma underwent retroperitoneal laparoscopic nephrectomy on both sides. Extracorporeal tumorectomy and renal reconstruction were performed on the side of the smaller tumor and then kidney autotransplantation was performed...
October 13, 2016: Urologia Internationalis
Masahiro Sugiura, Takahito Suyama, Manato Kanesaka, Ayumi Fujimoto, Kyokushin Hou, Kazuhiro Araki, Hiroshi Masuda, Satoko Kojima, Yukio Naya
OBJECTIVES: The aim of this study was to investigate the clinical usefulness for prediction of outcome of laparoscopic partial nephrectomy (LPN) using the R.E.N.A.L nephrometry scoring system (RNS) and centrality index score (C-index). MATERIALS AND METHODS: We retrospectively reviewed 64 patients who underwent LPN from 2010 to 2014 in our institution. The RNS and C-index scores were assigned according to the described protocols for their systems. The relationships between the patients' scores before surgery and the outcomes of LPN, warm ischemia time (WIT), operative time (ORT), estimated blood loss (EBL), and percent change in estimated glomerular filtration rate (eGFR) were analyzed retrospectively...
October 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
B Barrou, N Chatauret, T Hauet, R Thuret, F Kleinclauss, M-O Timsit, R Codas, X Matillon, L Badet
AIMS: To describe ischemia-reperfusion mechanisms, the impact on kidney graft and strategies developed to minimize ischemia-reperfusion damages. MATERIAL AND METHODS: An exhaustive systematic review of the scientific literature was performed in the Medline database ( and Embase ( using different associations of the following keywords: ischemia-reperfusion; organ preservation; hypothermic machine perfusion; renal transplantation...
September 29, 2016: Progrès en Urologie
Beatriz Prieto-Moure, José M Lloris-Carsí, Mariola Belda-Antolí, Luis H Toledo-Pereyra, Dolores Cejalvo-Lapeña
Allopurinol is a well-known antioxidant that protects tissue against ischemia and reperfusion injury, blocking purine catabolism, and possibly reducing TNF-α and other cytokines. It also plays a significant role in reducing the inflammatory processes by inhibiting chemotaxis and other inflammatory mediators. The objective of this study was to define the role of allopurinol regarding kidney ischemic injury particularly as to its effect on inflammatory molecules such as TNF-α, IL-1β, and IL-6 response. One hundred and twenty five rats were subjected to warm renal ischemia...
October 3, 2016: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Kristina Thamm, Florence Njau, Paul Van Slyke, Daniel J Dumont, Joon-Keun Park, Hermann Haller, Sascha David
AIM: To investigate the therapeutic potential of vasculotide (VT) - a Tie2 activating therapeutic - in kidney transplantation. METHODS: We performed a murine MHC-mismatched renal transplant model (C57Bl/6 male into Balb/c female) with 60 min cold and 30 min warm ischemia time. 500 ng VT was administered i.p. to donor mice 1 h before organ removal. In addition, recipients received 500 ng VT i.p. directly and 3 d after surgery. Survival was monitored and remaining animals were sacrificed 28 d after transplantation...
September 24, 2016: World Journal of Transplantation
Longfei Liu, Lin Qi, Yangle Li, Minfeng Chen, Chao Li, Xu Cheng, Peihua Liu, Xiongbing Zu
OBJECTIVES: T1 ventral renal hilar tumors (VRHTs) represent a very special type of tumor, for which laparoscopic partial nephrectomy (LPN) by the retroperitoneal approach is challenging. In this study, we report our surgical technique and Trifecta results. METHODS: Renal rotation technique has been established for retroperitoneal laparoscopic partial nephrectomy (RLPN) for VRHTs in our institution. Trifecta was used as a composite outcome measure for assessing quality of PLPN using this technique...
September 26, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Desiree D Rosselli, Jennifer L Mumaw, Vanna Dickerson, Cathy A Brown, Scott A Brown, Chad W Schmiedt
OBJECTIVE: To evaluate the effects of allogeneic mesenchymal stem cells (MSCs) in a model of ischemic acute kidney injury (AKI). STUDY DESIGN: Randomized controlled trial. ANIMALS: Adult, purpose-bred research cats (n=15) and a historical reference group (n=3). METHODS: Cats underwent unilateral, in vivo, warm renal ischemia, then intravenous administration of 4 million adipose-derived MSCs, bone marrow-derived MSCs, or fibroblasts (n=5/treatment) 1h after reperfusion...
October 2016: Research in Veterinary Science
J Moritz Kaths, Jun Yu Cen, Yi Min Chun, Juan Echeverri, Ivan Linares, Sujani Ganesh, Paul Yip, Rohan John, Darius Bagli, Istvan Mucsi, Anand Ghanekar, David Grant, Lisa A Robinson, Markus Selzner
Hypothermic preservation is known to cause renal graft injury, especially in donation after circulatory death (DCD) kidney transplantation. We investigated the impact of cold storage (SCS) vs. short periods of normothermic ex vivo kidney perfusion (NEVKP) after SCS vs. prolonged, continuous NEVKP with near avoidance of SCS on kidney function after transplantation. Following 30 minutes of warm ischemia, kidneys were removed from 30kg Yorkshire pigs and preserved for 16h with: A) 16h SCS, B) 15h SCS + 1h NEVKP, C) 8h SCS + 8h NEVKP, D) 16h NEVKP...
September 20, 2016: American Journal of Transplantation
Jihad H Kaouk, Ercan Malkoç
Nephron sparing surgery (NSS) is the gold standard treatment option for patients with a solitary kidney in order to preserve renal function. Open partial nephrectomy (OPN) has been long considered the standard care for NSS. Robotic partial nephrectomy (RPN) is being gradually used more commonly even for solitary kidney and complex tumors. There was no difference between RPN and OPN regarding the rate of intraoperative-postoperative complications and positive surgical margin (PSM) (RPN: 7.5%, OPN: 8%) for patients with solitary kidney who underwent partial nephrectomy for small renal masses...
September 2016: Turkish Journal of Urology
Ali Abdel Raheem, Atalla Alatawi, Irela Soto, Dae Keun Kim, Lawrence Hc Kim, Glen Denmer Santok, Trenton Gh Lum, Young Deuk Choi, Koon Ho Rha
OBJECTIVES: To analyze long-term outcomes of robot-assisted partial nephrectomy for treatment of complex cystic renal tumors. METHODS: We retrospectively analyzed the data of patients who underwent robot-assisted partial nephrectomy for cystic (n = 32) and solid (n = 263) renal masses at Severance Hospital, Seoul, Korea. The primary outcome was assessment of perioperative safety for cystic tumor. Secondary outcomes were evaluation of long-term oncological and functional results...
September 12, 2016: International Journal of Urology: Official Journal of the Japanese Urological Association
Louis S Krane, Charles C Peyton, Michael A Olympio, Ashok K Hemal
OBJECTIVE: To perform a randomized control trial (RCT) assessing the effect of phosphodiesterase 5 inhibitor (PDE5i) used prior to hilar clamping during robot assisted partial nephrectomy (RAPN) for renoprotection. MATERIALS AND METHODS: We performed an institutional review board approved, placebo controlled, double blinded RCT evaluating a single 100 mg oral dose of sildenafil immediately prior to RAPN. Primary end point was accrual, participation and retention of patients with secondary endpoints assessing post-operative renal functional outcomes and safety...
September 9, 2016: Journal of Surgical Oncology
Fatima Z Husain, Daniel C Rosen, David J Paulucci, John P Sfakianos, Ronney Abaza, Ketan K Badani
OBJECTIVE: To assess the association between the R.E.N.A.L. Nephrometry score, the amount of non-neoplastic parenchymal volume (NNPV) removed, and the renal function decline in patients undergoing robotic partial nephrectomy (RPN). PATIENTS AND METHODS: The Multi-institutional Mount Sinai Kidney Cancer Database was used to identify 1235 patients who underwent RPN between January 2008 and February 2016, of whom 366 had complete data, including NNPV removed. Mann-Whitney U tests and univariable linear regression models were used to assess the relationships between R...
October 2016: Journal of Endourology
Kyle A Blum, David J Paulucci, Ronney Abaza, Daniel D Eun, Akshay Bhandari, Joan C Delto, Louis S Krane, Ashok K Hemal, Ketan K Badani
OBJECTIVE: To compare renal function outcome between a contemporary cohort of propensity score-matched patients undergoing main renal artery clamping (MAC) alone and those undergoing main renal artery clamping with renal vein clamping (MVAC) during robotic partial nephrectomy. MATERIALS AND METHODS: Patients with a solitary T1 renal mass undergoing robotic partial nephrectomy were propensity score-matched on American Society of Anesthesiologists score, RENAL Nephrometry score, tumor size, tumor laterality, and operating surgeon to provide 66 patients undergoing MAC and 66 patients undergoing MVAC for analysis...
August 26, 2016: Urology
Alberto Lázaro, Blanca Humanes, Juan Carlos Jado, Marina Mojena, María Ángeles González-Nicolás, Juan Francisco Del Cañizo, Alberto Tejedor, Enrique Lledó-García
Warm ischemia (WI) produces a significant deleterious effect in potential kidney grafts. Hypothermic machine perfusion (HMP) seems to improve immediate graft function after transplant. Our aim was to analyze the effect of short pretransplant periods of pulsatile HMP on histology and renal injury in warm-ischemic kidneys. Twelve minipigs were used. WI was achieved in the right kidney by applying a vascular clamp for 45 min. After nephrectomy, autotransplant was performed following one of two strategies: cold storage of the kidneys or cold storage combined with perfusion in pulsatile HMP...
2016: BioMed Research International
H X Zhang, L Zhao, L L Ma, X F Hou, L Liu, S H Deng
OBJECTIVE: To evaluate the safety and efficacy of retroperitoneal laparoscopic nephrectomy with autotransplantation in cases of severe iatrogenic proximal ureteral damage. METHODS: From July 2011 to March 2015, two patients, aged 44 (female) and 54 years (male), underwent retroperitoneal laparoscopic nephrectomy and autotransplantation for treatment of severe iatrogenic proximal ureteral injuries. Both injuries were proximal ureteral avulsion during ureterolithotomy with the holmium laser for ureteral calculi...
February 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Riccardo Schiavina, Giacomo Novara, Marco Borghesi, Vincenzo Ficarra, Rajesh Ahlawat, Daniel A Moon, Francesco Porpiglia, Benjamin J Challacombe, Prokar Dasgupta, Eugenio Brunocilla, Gaetano La Manna, Alessandro Volpe, Hema Verma, Giuseppe Martorana, Alexandre Mottrie
OBJECTIVES: To evaluate and compare the correlations between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) and R.E.N.A.L. [Radius (tumour size as maximal diameter), Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior (a)/posterior (p) descriptor and the Location relative to the polar line] nephrometry scores and perioperative outcomes and postoperative complications in a multicentre, international series of patients undergoing robot-assisted partial nephrectomy (RAPN) for masses suspicious for renal cell carcinoma (RCC)...
August 16, 2016: BJU International
Steffen Lebentrau, Sven Rauter, Daniel Baumunk, Frank Christoph, Frank König, Matthias May, Martin Schostak
INTRODUCTION: If technically feasible, organ-preservation is indicated for T1 renal cell carcinoma (RCC), since partial nephrectomy (PN) is equivalent to radical nephrectomy with regard to tumor-specific survival and probably achieves better overall survival. Treatment results of a training clinic were assessed with regard to guideline adherence and treatment quality. METHODS: Based on 220 open interventions in the time periods 2006-2009 (TP1) and 2010-2013 (TP2), a retrospective single center examination was performed to determine the influence of patient-age, sex, BMI, ASA-score, preoperative eGFR, PADUA-score and surgeon's experience on PN-rate and trifecta-outcome (R0 resection, warm ischemia time ≤25 min, no intraoperative complications and no blood-transfusion and postoperative complications grade ≤1 Clavien and Dindo)...
August 12, 2016: World Journal of Urology
Jens J Rassweiler, Jan Klein, Alexandra Tschada, Ali Serdar Gözen
OBJECTIVES: To present technique and long-term results of retroperitoneal laparoscopic partial nephrectomy (LPN) focussing on the impact of an ergonomic platform. PATIENTS AND METHODS: Between January 2000 and May 2016, 287 patients (193 male, 94 female) underwent LPN by four surgeons. Median age was 59 (19-85) years. Mean tumour size was 3.1 (1-9) cm. Mean PADUA-score was 7.3 (6-12). Access was retroperitoneal in 235 (82%) cases. Since October 2010, we used ETHOS(TM) -chair during excision of the tumour in 130 (45...
August 12, 2016: BJU International
Solenne Tillet, Sébastien Giraud, Thomas Kerforne, Thibaut Saint-Yves, Sandrine Joffrion, Jean-Michel Goujon, Jerôme Cau, Gérard Mauco, Maurice Petitou, Thierry Hauet
Coagulation is an important pathway in the pathophysiology of ischemia-reperfusion injuries. In particular, deceased after circulatory death (DCD) donors undergo a no-flow period, a strong activator of coagulation. Hence, therapies influencing the coagulation cascade must be developed. We evaluated the effect of a new highly specific and effective anti-Xa/IIa molecule, with an integrated innovative antidote site (EP217609), in a porcine preclinical model mimicking injuries observed in DCD donor kidney transplantation...
July 25, 2016: Translational Research: the Journal of Laboratory and Clinical Medicine
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