Ileal and colon conduits in renal transplantation

Rainer W G Gruessner, P. J. Tzardis, A. J. Matas, D. L. Dunn, W. D. Payne, D. E R Sutherland, J. S. Najarian

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Twenty-five years ago the first case of renal transplantation into an ileal conduit was performed at this institution. Since then, 16 patients (9 females, 7 males) with an anverage age of 24.8 yr (range 9 to 47 yr) have undergone 19 transplants into intestinal conduits. The indication was neurogenic bladder in 7 cases, major urinary tract abnormalities in 7, and vesicoureteral reflux in 2. In primary transplants, 8 kidneys were from living related donors and 8 from cadaver donors; in retransplants, 1 kidney was from a living related and 2 from cadaver donors. In all but 3 cases the intestinal loop was constructed at least 2 weeks pretransplant. An ileal loop was used in 14 cases; a colon loop in 2. Conduit-specific complications were: calculi (n=2), small-bowel-to-ileal-loop fistula with hyperchloremic hyperkalemic acidosis (n=1), urinary fistula (n=1), and recurrent UTIs (n=12). Urosepsis caused 4 deaths. As of 9/89, 9 of these 16 patients are alive with functioning grafts (1 retransplant), 1 is alive without a functioning graft, and 6 died [urosepsis (4), ARDS (1), pneumonia (1)]. All of the 9 patients have had functioning grafts for more than 1 hr, 5 for more than 5 yr and 3 more than 10 yr. Of the 9 functioning grafts, 6 were from living related donors and 3 from cadaver donors. Patients were divided into two groups based on time of transplantation: Group I (11/64-4/77) and Group II (5/77-9/89). In Group I, 6 of 9 patients died; 1 is alive, but without a functioning graft, and only 2 still have functioning grafts. In Group II, no patient has died and 6 of 7 primary grafts still are functioning. Improvements in immunosuppression, surgical technique, infection treatment, and selection criteria are responsible for higher graft and patient survival in Group II.

Original languageEnglish (US)
Pages (from-to)125-128
Number of pages4
JournalClinical Transplantation
Volume4
Issue number3
StatePublished - 1990
Externally publishedYes

Fingerprint

Urinary Diversion
Kidney Transplantation
Colon
Transplants
Cadaver
Living Donors
Tissue Donors
Urinary Fistula
Kidney
Neurogenic Urinary Bladder
Calculi
Graft Survival
Acidosis
Urinary Tract
Immunosuppression
Patient Selection
Fistula
Pneumonia
Transplantation

Keywords

  • colon
  • conduits
  • ileal
  • renal Tx

ASJC Scopus subject areas

  • Immunology
  • Transplantation

Cite this

Gruessner, R. W. G., Tzardis, P. J., Matas, A. J., Dunn, D. L., Payne, W. D., Sutherland, D. E. R., & Najarian, J. S. (1990). Ileal and colon conduits in renal transplantation. Clinical Transplantation, 4(3), 125-128.

Ileal and colon conduits in renal transplantation. / Gruessner, Rainer W G; Tzardis, P. J.; Matas, A. J.; Dunn, D. L.; Payne, W. D.; Sutherland, D. E R; Najarian, J. S.

In: Clinical Transplantation, Vol. 4, No. 3, 1990, p. 125-128.

Research output: Contribution to journalArticle

Gruessner, RWG, Tzardis, PJ, Matas, AJ, Dunn, DL, Payne, WD, Sutherland, DER & Najarian, JS 1990, 'Ileal and colon conduits in renal transplantation', Clinical Transplantation, vol. 4, no. 3, pp. 125-128.
Gruessner RWG, Tzardis PJ, Matas AJ, Dunn DL, Payne WD, Sutherland DER et al. Ileal and colon conduits in renal transplantation. Clinical Transplantation. 1990;4(3):125-128.
Gruessner, Rainer W G ; Tzardis, P. J. ; Matas, A. J. ; Dunn, D. L. ; Payne, W. D. ; Sutherland, D. E R ; Najarian, J. S. / Ileal and colon conduits in renal transplantation. In: Clinical Transplantation. 1990 ; Vol. 4, No. 3. pp. 125-128.
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AB - Twenty-five years ago the first case of renal transplantation into an ileal conduit was performed at this institution. Since then, 16 patients (9 females, 7 males) with an anverage age of 24.8 yr (range 9 to 47 yr) have undergone 19 transplants into intestinal conduits. The indication was neurogenic bladder in 7 cases, major urinary tract abnormalities in 7, and vesicoureteral reflux in 2. In primary transplants, 8 kidneys were from living related donors and 8 from cadaver donors; in retransplants, 1 kidney was from a living related and 2 from cadaver donors. In all but 3 cases the intestinal loop was constructed at least 2 weeks pretransplant. An ileal loop was used in 14 cases; a colon loop in 2. Conduit-specific complications were: calculi (n=2), small-bowel-to-ileal-loop fistula with hyperchloremic hyperkalemic acidosis (n=1), urinary fistula (n=1), and recurrent UTIs (n=12). Urosepsis caused 4 deaths. As of 9/89, 9 of these 16 patients are alive with functioning grafts (1 retransplant), 1 is alive without a functioning graft, and 6 died [urosepsis (4), ARDS (1), pneumonia (1)]. All of the 9 patients have had functioning grafts for more than 1 hr, 5 for more than 5 yr and 3 more than 10 yr. Of the 9 functioning grafts, 6 were from living related donors and 3 from cadaver donors. Patients were divided into two groups based on time of transplantation: Group I (11/64-4/77) and Group II (5/77-9/89). In Group I, 6 of 9 patients died; 1 is alive, but without a functioning graft, and only 2 still have functioning grafts. In Group II, no patient has died and 6 of 7 primary grafts still are functioning. Improvements in immunosuppression, surgical technique, infection treatment, and selection criteria are responsible for higher graft and patient survival in Group II.

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