Article

The role of stent and cotrimoxazole in prevention of UTI after kidney transplantation.

Division of Transplantation of Emam Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Transplantation Proceedings (Impact Factor: 0.95). 09/2001; 33(5):2667. DOI: 10.1016/S0041-1345(01)02138-8
Source: PubMed
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    ABSTRACT: Zusammenfassung Die urologisch-chirurgischen Techniken der Nierentransplantation sind standardisiert und haben in den letzten 50 Jahren kaum wichtige nderungen erfahren. Durch den anhaltenden Spendermangel kommen aber zunehmend technisch anspruchsvolle operative Verfahren und marginale Organe zum Einsatz. Das betrifft Kinderspendernieren, anatomische Varianten, En-bloc-Transplantationen und Mehrfachgefversorgungen. Die operativ-technischen Entwicklungen (z. B. laparoskopische Techniken) sind auch im Bereich der Nierentransplantation etabliert. Wir geben mit unserem Artikel einen berblick ber den Standard der Technik der Nierentransplantation, mglicher chirurgischer und urologischer Komplikationen, Ergebnisse des eigenen Patientenguts und gehen auf technische Modifikationen bezglich der Gefnahttechniken, Besonderheiten im Kindesalter, Management von Komplikationen und auf Sonderflle sowie experimentelle Verfahren ein. Abstract Surgical techniques in renal transplantation are standardized and have remained basically unchanged for the last 50 years. A limited pool of donor organs is still an unsolved problem. Therefore, marginal organs are also used. Sophisticated techniques are used in children and in cases with vascular problems or complications. Laparoscopic techniques are emerging in renal transplantation. The article provides an overview on current technical standards of renal transplantation and potential surgical and urological complications. We report the results of our own renal transplantation program with special emphasis on vascular techniques, pediatric transplantation, and the management of complications. Special case reports are included.
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    ABSTRACT: The early urinary tract infection (EUTI) in kidney transplant recipients is an infection develop during the first 3 months post transplant surgery. The effect of EUTI on graft survival and risk factors have been scarcely studied. Our objetives were the evaluation of risk factors to EUTI, the assessment of the causal agent and graft survival impact. A retrospective analysis of kidney transplantation, period 1997-2000 in Hospital Privado-Centro Médico de Córdoba was carried out. There were two groups of patients with (EUTI group) and without EUTI (control group). Cox model was used to analyze risk factors and Kaplan-Meier method for graft survival. A total of 226 consecutive patients received kidney transplantation. In 55 patients (24.3%) EUTI was detected. Risk factors for EUTI were: invasive urological maneuvers (RR = 4.34, CI 95% 1.42-13.21), diabetes mellitus (RR = 3.79, CI 95% 1.42-10.14), cytomegalovirus infection (RR = 2.9, CI 95% 1.02-8.24) and previous transplants (RR = 2.83, CI 95% 1.08-7.45). Delayed graft function was associated with lower incidence of EUTI (RR = 0.38, CI 95% 0.15-0.94). The causal agents were: Klebsiella pneumoniae (36%), Pseudomonas aeruginosa (24%) and Escherichia coli (9%). Graft survival at 2 years was similar in EUTI (87.2%) and control group (81.2%, p = 0.32). This series shows that invasive urological maneuvers were the main risk factors for EUTI. Graft survival was similar. High prevalence of non coli bacteria need further evaluation.
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    ABSTRACT: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function. All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent. Overall, 196 (183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3% (12/277) with no difference between those with or without stents - 7/183 vs 5/102, P = 0.746. Overall, 54% (99/183) of stented patients developed a urological infection compared to 38.1% (32/84) of those without stents (P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent (Wald χ(2) = 5.505, P = 0.019) and diabetes mellitus (Wald χ(2) = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo. Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.
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