• Drainage
• Kidney transplantation
• Lymphocele
• Lymphocèle
• Transplantation rénale

• Humans
• Kidney Transplantation/adverse effects
• Drainage
• Male
• Female
• Risk Factors
• Middle Aged
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Adult
• Postoperative Care/methods
• Retrospective Studies

• Basket trial
• Gene sequencing
• Molecular profiling
• Pediatric cancer
• Precision medicine
• Precision oncology
• Targeted therapy

• Child
• Humans
• Neoplasms/genetics
• Neoplasms/surgery
• Neoplasms/drug therapy
• Precision Medicine
• Medical Oncology
• Antineoplastic Agents/therapeutic use
• Mutation
• Molecular Targeted Therapy

• heart transplant
• mammalian target of rapamycin inhibitors
• surgical site wound infection
• wound complication

• Humans
• Immunosuppressive Agents/adverse effects
• TOR Serine-Threonine Kinases
• Heart Transplantation/adverse effects

• XN201930 Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of the Ministry of Education

• arterial embolization
• everolimus
• partial nephrectomy
• renal angiomyolipoma
• tuberous sclerosis complex

• Pediatric vascular anomalies
• Sirolimus
• Surgical wound complications
• Vascular malformations

Mammalian target of rapamycin inhibitors (mTOR-I) lacks nephrotoxicity, has antineoplastic effects, and reduces viral infections in kidney transplant recipients. Earlier studies reported a significant incidence of wound healing complications and lymphocele. This resulted in the uncomfortable willingness of transplant clinicians to use these agents in the immediate posttransplant period. As evidence and experience evolved over time, much useful information became available about the optimal use of these agents. Understandably, mTOR-I effects wound healing through their antiproliferative properties. However, there are a lot of other immunological and nonimmunological factors which can also contribute to wound healing complications. These risk factors include obesity, uremia, increasing age, diabetes, smoking, alcoholism, and protein-energy malnutrition. Except for age, the rest of all these risk factors are modifiable. At the same time, mycophenolic acid derivatives, steroids, and antithymocyte globulin (ATG) have also been implicated in wound healing complications. A lot has been learnt about the optimal dose of mTOR-I and their trough levels, its combinations with other immunosuppressive medications, and patients' profile, enabling clinicians to use these agents appropriately for maximum benefits. Recent randomized control trials have further increased the confidence of clinicians to use these agents in immediate posttransplant periods.

Background: Contrasting results have emerged from limited studies investigating the role of prophylactic surgical drainage in preventing wound morbidity after liver and kidney transplantation. This retrospective study analyzes the use of surgical drain and the incidence of wound complications in combined liver and kidney transplantation (CLKTx).

Methods: A total of 55 patients aged ≥18 years were divided into two groups: the drain group (D) (n = 35) and the drain-free group (DF) (n = 20). Discretion to place a drain was based exclusively on surgeon preference. All deceased donor kidneys were connected to the LifePort Renal Preservation Machine® prior to transplantation, in both simultaneous and delayed technique of implantation of the renal allograft. The primary outcome was the development of superficial/deep wound complications during the study follow-up. Secondary outcomes included the development of delayed graft function (DGF) of the transplanted kidney, primary non-function (PNF) and early allograft dysfunction (EAD) of the transplanted liver, graft failure, graft and patient survival, overall post-operative morbidity rate and length of hospital stay.

Results: With a median follow-up of 14.4 months after transplant, no difference in the incidence of superficial/deep wound complications, except for hematomas, in collections size, intervention rate, PNF, EAD, graft failure and patient survival, was observed between the 2 groups. Significantly lower level of platelets, higher INR values, DGF, morbidity rates and length of hospital stay were reported post-operatively in the D group. Pre-operative hypoalbuminemia and longer CIT were included in the propensity score for receiving a drain and were associated with a significantly higher rate of developing a hematoma post-transplant.

Conclusions: Absence of the surgical drain did not appear to adversely affect wound morbidity compared to the prophylactic use of drains in renal transplant patients during CLKTx.

• DGF
• combined liver and kidney transplantation
• graft failure
• prophylactic drainage
• wound complications

• intraperitoneal ultrasound
• laparoscopic fenestration
• lymphocele

Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value.

To determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors.

Retrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. did (Drain, D) receive a drain at the time of transplant was performed. The primary outcome was the development of any wound complication (superficial or deep) during the first 12 months post-transplant. Secondary outcomes included the development of superficial wound complications, deep wound complications, DGF, and graft loss during the first 12 months post-transplant.

388 and 112 recipients had DF/D, respectively. DF-recipients were significantly more likely to be younger, not have pre-transplant diabetes, receive a living donor kidney, receive a kidney-alone transplant, have a shorter duration of dialysis, shorter mean cold-ischemia-time, and greater pre-transplant use of anticoagulants/antiplatelets. Wound complications were 4.6% (18/388) vs. 5.4% (6/112) in DF vs. D groups, respectively (P = 0.75). Superficial wound complications were observed in 0.8% (3/388) vs. 0.0% (0/112) in DF vs. D groups, respectively (P = 0.35). Deep wound complications were observed in 4.1% (16/388) vs. 5.4% ((6/112) in DF vs. D groups, respectively (P = 0.57). Higher recipient body mass index and ≥ 1 year of pre-transplant dialysis were associated in multivariable analysis with an increased incidence of wound complications. Once the prognostic influence of these 2 factors were controlled, there was still no notable effect of drain use (yes/no). The lack of prognostic effect of drain use was similarly observed for the other clinical outcomes.

In a relatively large cohort of renal transplant recipients, routine surgical drain use appears to offer no distinct prognostic advantage.

• Collection
• Drain-free
• Kidney transplant
• Lymphocele
• Wound

• Molecular therapy
• Pediatric MATCH
• Pediatric cancer
• Precision medicine

Renal transplantation often causes polyuria, and a Foley catheter is typically placed after transplantation. A urethral stricture often makes it difficult to insert a normal diameter urethral catheter.

We report on the case of a 16‐year‐old adolescent male with a history of hypospadias surgery who underwent a cystostomy during renal transplantation. A cystostomy was placed during transplantation because of stricture of the pendulous urethra. Urine leakage into the retroperitoneum occurred after cystostomy catheter removal. An 8‐Fr urethral catheter was placed, and urine was aspirated to prevent drainage failure. Voiding cystourethrography performed after 2 weeks showed that there was no leakage. After that, the patient had no trouble with urination.

A cystostomy may be one strategy for renal transplantation patients with a urethral stricture. Urine leak can occur because of the delay in wound healing caused by immunosuppressive therapy. Therefore, cystostomy management strategies should be considered carefully.

• cystostomy
• renal transplantation
• urethral stricture
• urine leakage

Although gastroduodenal ulcers are common in solid organ transplant patients, there are few reports on multiple giant ulcers in the distal ileum and ileocecal valve caused by immunosuppressants Herein, we report on a liver transplant recipient and a renal transplant recipient with multiple large ulcers in the distal ileum and ileocecal valve who rapidly achieved ulcer healing upon withdrawal of sirolimus or tacrolimus and administration of thalidomide. In case 1, a 56-year-old man with primary hepatocellular carcinoma had received a liver transplantation. Tacrolimus combined with sirolimus and prednisolone was used as the anti-rejection regimen. Colonoscopy was performed because of severe abdominal pain and diarrhea at post-operative month 10. Multiple giant ulcers were found at the ileocecal valve and distal ileum. The ulcers healed rapidly with withdrawal of sirolimus and treatment with thalidomide. There was no recurrence during 2 years of follow-up. In case 2, a 34-year-old man with end-stage kidney disease received kidney transplantation and was put on tacrolimus combined with mycophenolate mofetil and prednisolone as the anti-rejection regimen. Twelve weeks after the operation, the patient presented with hematochezia and severe anemia. Colonoscopy revealed multiple large ulcers in the ileocecal valve and distal ileum, with massive accumulation of fresh blood. The bleeding ceased after treatment with intravenous somatostatin and oral thalidomide. Tacrolimus was withdrawn at the same time. Colonoscopy at week 4 of follow-up revealed remarkable healing of the ulcers, and there was no recurrence of bleeding during 1 year of follow-up. No lymphoma, tuberculosis, or infection of cytomegalovirus, Epstein-Barr virus, or fungus was found in either patient. In post-transplantation cases with ulcers in the distal ileum and ileocecal valve, sirolimus or tacrolimus should be considered a possible risk factor, and withdrawing them or switching to another immunosuppressant might be effective to treat these ulcers.

• Ileal ulcers
• Liver transplantation
• Kidney transplantation
• Sirolimus
• Tacrolimus

• Adult
• Colonoscopy
• Deprescriptions
• Gastrointestinal Hemorrhage/chemically induced
• Gastrointestinal Hemorrhage/pathology
• Graft Rejection/prevention & control
• Humans
• Ileal Diseases/chemically induced
• Ileal Diseases/pathology
• Immunosuppressive Agents/adverse effects
• Kidney Transplantation
• Liver Transplantation
• Male
• Middle Aged
• Mycophenolic Acid/therapeutic use
• Prednisolone/therapeutic use
• Sirolimus/adverse effects
• Tacrolimus/adverse effects
• Ulcer/chemically induced
• Ulcer/pathology

• Everolimus
• NODAT
• mTOR inhibitor
• rapamycin
• sirolimus
• solid organ transplant

In renal transplanted patients, lymphoceles and lymphorrhea are well-known lymphatic complications. Surgical damage of the lymphatics of the graft during the procurement and of the lymphatic around the iliac vessels of the recipients has been associated with development of lymphatic complications. However, lymphatic complications may be related to medical factors such as diabetes, obesity, blood coagulation abnormalities, anticoagulation prophylaxis, high dose of diuretics, delay in graft function and immunosuppressive drugs. Consistently, immunosuppression regimens based on the use of mTOR inhibitors, especially in association with steroids and immediately after transplantation, has been associated with a high risk to develop lymphocele or lymphorrhea. In addition, several studies have demonstrated the association between rejection episodes and lymphatic complications. However, before the discovery of reliable markers of lymphatic vessels, the pathogenic mechanisms underlining the development of lymphatic complications during rejection and the influence of mTOR inhibitors remained not fully understood. The recent findings on the lymphatic systems of either native or transplanted kidneys together with the advances achieved on lymphangiogenesis shared some lights on the pathogenesis of lymphatic complications after renal transplantation. In this review, we describe the surgical and medical causes of lymphatic complications focusing on the rejection and immunosuppressive drugs as causes of lymphatic complications.

• kidney transplantation
• lymphocele
• lymphorrhea
• mTOR inhibitors
• rejection

• Transplantation

• Calciphylaxis
• Renal impairment
• Uremic toxins
• Wound healing

• kidney transplantation
• obesity
• sirolimus
• wound healing

• complications
• everolimus
• kidney transplantation
• lymphocele
• wound healing

• Adult
• Cyclosporine/therapeutic use
• Everolimus
• Female
• Follow-Up Studies
• Glomerular Filtration Rate
• Graft Rejection/prevention & control
• Graft Survival/drug effects
• Humans
• Immunosuppressive Agents/therapeutic use
• Kidney Function Tests
• Kidney Transplantation
• Male
• Middle Aged
• Mycophenolic Acid/analogs & derivatives
• Mycophenolic Acid/therapeutic use
• Prognosis
• Prospective Studies
• Randomized Controlled Trials as Topic
• Retrospective Studies
• Risk Factors
• Sirolimus/analogs & derivatives
• Sirolimus/therapeutic use
• Wound Healing/drug effects

• Contraindications
• Humans
• Immunosuppressive Agents/adverse effects
• Lung Diseases/chemically induced
• Lung Diseases/complications