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TRANSPLANTE RENAL: IMPLANTE DO ENXERTO E COMPLICAES

Inciso do receptor
Acesso retroperitoneal

Inciso de Gibson e Hockeystick

IMPLANTE VASCULAR
Anastomose tradicional: anastomose arterial primeiro : reduz tempo de ocluso venosa e risco de TVP. Veia costuma ser mais longa e por isso maior risco de kink e trombose da veia. Dar preferncia do rim doado esquerdo (veia mais longa) a ser implantado na fossa ilaca direita

IMPLANTE VASCULAR
FIO PROLENE 6-0 NA VEIA E 5-0 NA ARTERIA

SUSPRESAS...

IMPLANTE VASCULAR

Segunda opo: complicao impotncia

IMPLANTE VASCULAR

IMPLANTE VASCULAR

Outra opo

MAIS SURPRESAS: ARTRIAS MLTIPLAS


TCNICAS DE RECONSTRUO ARTERIAL DO ENXERTO

TCNICAS PARA ALONGAR VEIA RENAL

DOADOR RENAL INFANTIL

DIURESE PRESENTE

IMPLANTE URETERAL

Lich-Gregoir (MacKinnon)

IMPLANTE URETERAL

IMPLANTE URETERAL
OUTRAS TCNICAS DE URETERONEOCISTOSTOMIA
Politano-Leadbetter Taniguch

COMPLICAES CLNICAS DA IMUNOSUPRESSO



INDIRETAS DIRETAS Infeces Cushing - Fungos D. mellitus Gastrite/UGD - Bactrias Pancreatite - Vrus Mielodepresso - Parasitas Nefrotoxicidade Neoplasias Hepatotoxicidade Alterao comportamental Kidney transplant recipients are more Catarata likely to develop cancer than ageNecrose ssea matched subjects in the general

population and patients wait-listed for deceased donor renal transplantation ( Kasiske et al, 2004).

COMPLICAES CLNICAS DA IMUNOSUPRESSO

Complicao imunolgica

Complicaes vasculares
Estenose de artria renal: 1,7% Trombose de artria renal: 1,7% Trombose de veia renal: 1,4% Linfocele: 12%

Risaliti A et all; G Ital Nefrol. 2004.

Complicao vascular

Surgical intervention for transplant renal artery stenosis is difficult, with a significant risk of technical failure, and percutaneous transluminal angioplasty, with or without endoluminal stent placement, has become the initial treatment of choice ( Nicita et al, 1998 ).

COMPLICAES UROLOGICAS
Because the renal transplant is denervated, the patient will not experience typical renal colic, and the diagnosis is suspected when renal function suddenly deteriorates or transplant pyelonephritis occurs

COMPLICAES UROLGICAS
ITU: 28,5% Fstula urinria: 6,7% Estenose ureteral: 1,4% Tratamento:
Minimamente invasivo Re-implante ureteral
Burmeister D et all; Urologe A. 2006

CAUSAS DE PERDA DO ENXERTO

(%)

Rejeio hiperaguda
Rejeio aguda

1,5
15,0

Rejeio crnica
Causa vascular

21,0
13,6

Causa urolgica
Recidiva da doena de base

0,0
2,8

bito c/ rim funcionante


Rutura renal

35,2
0,7

Unadjusted Graft and Patient Survival at 3 Months, 1 Year, 3 Years, 5 Years, and 10 YearsSurvival (%)

Source: OPTN/SRTR Data as of May 1, 2008

Urologe A. 2006 Jan;45(1):25-31. Review. German.[Urological complications after kidney transplantation.] [Article in German] Burmeister D, Noster M, Kram W, Kundt G, Seiter H. Urologische Klinik und Poliklinik, Universitt, E.-Heydemann-Strasse 6, 18055 Rostock. dirk.burmeister@med.uni-rostock.de Abstract Between August 1981 and May 2005, 1065 consecutive kidney transplants were performed at our center; 393 patients (36.9%) developed urological complications in the first 60 postoperative days. Urinary tract infections occurred in 28.5% of all patients. The major urological problems seen were urinary leakage and ureteral obstruction in 6.2% and 1.4% of the patients. Two grafts were lost due to severe urinary leakage. No patient death occurred due to urological complications. The incidence of urological complications is mainly influenced by the surgical procedure of organ retrieval and ureteroneocystostomy. With double-J stenting of the extravesical ureteroneocystostomy, we observed a significantly lower rate of urinary leakage but a higher rate of urinary tract infections in our series. Early diagnosis and treatment of urological complications may prevent further morbidity of our transplant patients.

G Ital Nefrol. 2004 Jan-Feb;21 Suppl 26:S43-7. [Surgical complications after kidney transplantation] [Article in Italian] Risaliti A, Sainz-Barriga M, Baccarani U, Adani GL, Montanaro D, Gropuzzo M, Tullissi P, Boscutti G, Lorenzin D, Mioni G, Bresadola F. Unita' Trapianti, Clinica Chirurgica dell'Universita' degli Studi di Udine, P.U.G.D. a.risaliti@med.uniud.it Abstract Chronic renal failure needs substitutive treatment such as haemodialysis and peritoneal dialysis for the patient to survive. Kidney transplantation (KTx) improves survival of the patient with chronic renal failure. Since the first KTx, performed by Merrill in Boston in 1959, advances in medical therapy, immunosuppressive therapy and refinements in surgical technique have improved the quality of life of the transplant patient. We present a review of the incidence, diagnosis and therapy of surgical complications after KTx reported in the literature and a retrospective analysis of 297 consecutive cadaveric donor kidney transplants done in our institution from September 1993 to September 2002. Vascular complications represent 5-10% of postoperative complications. Our experience showed an incidence of 1.7% renal artery thrombosis, 1.4% renal vein thrombosis, 1.7% renal artery stenosis, 1.4% arterial rupture due to fungal arteritis, 0.7% spontaneous graft ruptures and 12% lymphoceles. Urological complications account for 10-15% of postoperative complications. In our series we found an incidence of 7.4% urinary leakage, 2.7% urinary obstruction and 3% urinary reflux. Gastrointestinal complications represent 16% of postoperative complications. Our series showed 1% pancreatitis with an overall mortality of 33% and an incidence of 1.7% intestinal perforations. Surgical complications still represent a challenge that increments morbidity and mortality among kidney transplant recipients. Data shown may offer some guidance on how to deal with early and late post-transplant surgical complications.