Background The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of nondonors and that their risk of end-stage renal disease (ESRD) is not increased. Previous studies have included relatively small numbers of donors and a brief follow-up period. Methods We ascertained the vital status and lifetime risk of ESRD in 3698 kidney donors who donated kidneys during the period from 1963 through 2007; from 2003 through 2007, we also measured the glomerular filtration rate (GFR) and urinary albumin excretion and assessed the prevalence of hypertension, general health status, and quality of life in 255 donors. Results The survival of kidney donors was similar to that of controls who were matched for age, sex, and race or ethnic group. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, as compared with a rate of 268 per million per year in the general population. At a mean (±SD) of 12.2±9.2 years after donation, 85.5% of the subgroup of 255 donors had a GFR of 60 ml per minute per 1.73 m 2 of bodysurface area or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and higher body-mass index, but not a longer time since donation, were associated with both a GFR that was lower than 60 ml per minute per 1.73 m 2 and hypertension. A longer time since donation, however, was independently associated with albuminuria. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic group, and body-mass index. Conclusions Survival and the risk of ESRD in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved GFR, normal albumin excretion, and an excellent quality of life.

/pdf/long-term-consequences-of-kidney-donation-3cmet48vap.pdf

Long-Term Consequences of Kidney Donation

Experience with primary malignant lymphoma in the breast at the Barnes Hospital is reviewed and analyzed. Sixteen cases were found which satisfied our criteria. Eleven were classified as malignant lymphoma, histiocytic type, and five as lymphocytic type. No cases of Hodgkin's disease were identified. Several intesting associations were noted. Two cases were associated with pregnancy. One case was preceded by carcinoma and another by cystic mastitis; both cases were proved by biopsy. Bilateral breast involvement by tumor was seen four times. Primary mammary lymphoma is an aggressive disease, with a high predilection for the right breast. Histologically, the tumor tends to infiltrate between mammary ducts without destroying them. In spite of various therapies, only three patients survived 5 years.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/1097-0142%28197206%2929%3A6%3C1705%3A%3AAID-CNCR2820290640%3E3.0.CO%3B2-I

Primary lymphoma of the breast

OBJECTIVE: This study compares an initial group of patients undergoing laparoscopic live donor nephrectomy to a group of patients undergoing open donor nephrectomy to assess the efficacy, morbidity, and patient recovery after the laparoscopic technique. SUMMARY BACKGROUND DATA: Recent data have shown the technical feasibility of harvesting live renal allografts using a laparoscopic approach. However, comparison of donor recovery, morbidity, and short-term graft function to open donor nephrectomy has not been performed previously. METHODS: An initial series of patients undergoing laparoscopic live donor nephrectomy were compared to historic control subjects undergoing open donor nephrectomy. The groups were matched for age, gender, race, and comorbidity. Graft function, intraoperative variables, and clinical outcome of the two groups were compared. RESULTS: Laparoscopic donor nephrectomy was attempted in 70 patients and completed successfully in 94% of cases. Graft survival was 97% versus 98% (p = 0.6191), and immediate graft function occurred in 97% versus 100% in the laparoscopic and open groups, respectively (p = 0.4961). Blood loss, length of stay, parenteral narcotic requirements, resumption of diet, and return to normal activity were significantly less in the laparoscopic group. Mean warm ischemia time was 3 minutes after laparoscopic harvest. Morbidity was 14% in the laparoscopic group and 35% in the open group. There was no mortality in either group. CONCLUSIONS: Laparoscopic live donor nephrectomy can be performed with morbidity and mortality comparable to open donor nephrectomy, with substantial improvements in patient recovery after the laparoscopic approach. Initial graft survival and function rates are equal to those of open donor nephrectomy, but longer follow-up is necessary to confirm these observations.

Comparison of open and laparoscopic live donor nephrectomy.

During a period of 10 years, 51 patients were found to have metastatic cancer in the breast. There were 44 women and seven men. Eighteen patients had carcinoma, 16 had malignant lymphoma, 14 had malignant melanoma, and three had myosarcomas. It is interesting that 16 of the 51 patients had no prior history of malignant disease—the mammary lesion presenting as the first manifestation of an occult extramammary primary. Metastatic cancer should be suspected when a multinodular neoplasm is found in the superficial tissues of the breast. Forty-one patients had a rapidly fulminating course and died of disease. Ten patients are alive, seven with and three without apparent evidence of disease. It is concluded that earlier recognition of these tumors may lead to more rational therapy and avoidance of unnecessary radical surgery.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/1097-0142%28197206%2929%3A6%3C1691%3A%3AAID-CNCR2820290637%3E3.0.CO%3B2-4

Cancers metastatic to the breast.

This review found 10 studies that compared the blood pressure of kidney donors and healthy adults of similar age, sex, and ethnicity. Within 5 to 10 years of donation, the average blood pressure of...

/pdf/meta-analysis-risk-for-hypertension-in-living-kidney-donors-3ujm018ssk.pdf

Meta-Analysis: Risk for Hypertension in Living Kidney Donors

Living related donor (LRD) nephrectomies are controversial due to the risks to the donor and improved cadaveric graft survival using cyclosporine A. Between December 22, 1970, and December 31, 1984, 1096 renal transplants were performed at a single institution, 314 (28.6%) from LRD. The average age was 34.3 years (range: 18-67); none had preoperative hypertension. All nephrectomies were performed transabdominally. Major perioperative complications occurred in 22 (7.0%). These include wound infections (3.5%), pancreatitis (1.0%), injuries to spleen (1.0%) or adrenal gland (0.3%) requiring removal, pneumonitis (0.6%), ulnar nerve palsy (0.6%), femoral artery thrombosis after arteriogram (0.3%), pulmonary embolus (0.3%), and upper pole infarct of contralateral kidney (0.3%). There are six known deaths in this series, none of which were related to the operation. Major late complications were seen in 50 (20.0%) of 250 patients followed for 6 to 175 months (mean 53.1 months). These included definite hypertension (5.6%), suture granuloma (4.4%), incisional hernia (3.6%), proteinuria (2.4%), bowel obstruction (2.0%), nephrolithiasis (1.2%), wound infection (0.4%), scrotal hydrocele (0.4%), and chronic pancreatitis (0.4%). While the risk of hypertension appears to increase as the interval from donation increases, no cases of renal failure after donation have been noted, and negligible proteinuria among those followed long-term has been seen in this series. It is felt that living related kidney donation is justified when the relative is sincerely motivated and well informed prior to donation.

Living related kidney donors. A 14-year experience

A case of reticulum cell sarcoma of the breast with early dissemination and death despite combined therapy is reported. A literature review of 60 cases previously documented is presented. The age of occurrence is most frequent in the sixth decade. Rapid growth is the only characteristic physical finding of the lesion. The histologic pattern is predominated by a polymorphic reticular architecture. Long survival is reported following complete excision.

Reticulum cell sarcoma of the breast.

Renal artery dissections are stenotic or occlusive lesions most often observed in hypertensive patients with underlying atherosclerosis or fibromuscular disease. Acute dissections may present spontaneously, as a complication of diagnostic or therapeutic angiography or as an agonal event associated with overwhelming systemic illness. Chronic dissections may produce renovascular hypertension or be entirely asymptomatic. Fourteen renal artery dissections have been encountered in nine patients treated at Vanderbilt University Medical Center during the past decade. Eleven dissections have been found in seven patients with renovascular hypertension. Seven of these dissections were chronic (six functional, one silent) and four acute (two spontaneous, two secondary to angiography). Three agonal dissections were found in two additional patients postmortem: one at autopsy and bilateral dissections found at the time of cadaveric donor nephrectomy. Ten bypass procedures, including five complex branch reconstructions of which three were performed ex vivo, have been performed with 100% immediate patency and maintenance or improvement of renal function. Long-term follow-up of these patients has shown sustained patency of the reconstructed renal arteries, excellent blood pressure control, and normal renal function in all. Nephrectomy has not been required and there have been no associated deaths. Seventy-seven additional renal artery dissections in 72 patients collected from previous reports have been analyzed. Patient survival (55/72, 76.4%) and preservation of the involved kidney in surviving patients (26/55, 47.3%) were low in these earlier series. In addition, renal failure was associated with 59% of the deaths. The lethality of renal artery dissections and the ease and success of revascularization, which preserves renal function and ameliorates associated renovascular hypertension, emphasize the need for an aggressive approach to the recognition and treatment of this entity. Therapy should be directed toward arterial reconstructions and the preservation of functioning renal tissue.

Renal Artery Dissection

• Cutaneous chromomycosis occurred in two renal transplant recipients from the south central United States. Both patients have been managed successfully with surgical excision of isolated lesions, and the condition of one of these has been improved but not cured with low-dose ketoconazole therapy. Even in the immunocompromised host, localized cutaneous chromomycosis may not require more aggressive systemic antifungal chemotherapy. ( Arch Intern Med 1985;145:1036-1037)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=INTEMED&articleId=605810&pdfFileName=archinte_145_6_015.pdf

Cutaneous chromomycosis in renal transplant recipients. Successful management in two cases.

This study is a multifactorial analysis of 389 transplants performed from June 1977 to December 1981. Analysis of the effects of transfusions antilymphocyte serum (ALS), histocompatibility testing, gender, and patient risk factors (presence of concomitant disease, greater than 50 years of age, etc.) was done. Two-hundred fifty-three patients received cadaver kidneys and 136 patients obtained kidneys from a relative. Two-hundred eighty-three (73%) patients received blood transfusions prior to transplantation. Our data showed that recipients receiving transfusions prior to transplantation had a significantly higher graft survival than those who were not transfused in both cadaveric and related graft recipients. Two-hundred twenty-one (56%) patients received ALS following the transplant. This group had a 15% higher graft survival than a comparable group. Analysis of histocompatibility testing data shows approximately 5% higher functional graft survival between each match grade. Surprisingly, female patients receiving kidneys from living related donors had a 16% higher graft survival than male patients. In cadaver recipients female patients had a 10% higher patient survival as compared to male patients. The risk factor status of recipients affected not only graft survival but patient survival, which probably is due to the consequences of immunotherapy. The authors' conclusion is that the above mentioned factors may be additive in nature. Further, multivariable analysis is necessary in order to correctly transplant data.

Factors influencing the outcome of kidney transplants.

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