Best of AUA 2013: Transplantation/Vascular Surgery

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Presented by Daniel Shoskes, MD

Cleveland Clinic, Cleveland

• Subfascial delivery of local anesthetic significantly reduced narcotic use in patients undergoing laparo-endoscopic single-site donor nephrectomy.

• A continuous infusion of ketorolac (Toradol) following laparoscopic donor nephrectomy is effective, minimizes narcotic use, and had no negative impact on glomerular filtration rate compared with placebo.

• African-Americans have the lowest access to living kidney donors. The number of living donors appears to be decreasing with time, which may be due to social factors and the presence of comorbidities in potential donors.

• It appears to be safe and feasible to ship living donor kidneys over long distances.

• Researchers evaluating typical radiation exposure during living donor workup of 154 patients found that the mean total dose of radiation was 29 mSv, and 4.8% received more than 50 mSv. The maximum occupational radiation exposure for nuclear workers is 30 mSv. The researchers have since modified their protocols and reduced radiation exposure.

• A retrospective review of 6,480 transplant patients identified 17 patients who had bladder cancer. Three were diagnosed within 3 months of their transplant, suggesting it may have been a preexisting condition. Bladder cancer appears to present at a more advanced stage in transplant recipients versus non-transplant patients.

• Nephron-sparing surgery is feasible for de novo tumors found in transplant.

• Patients with end-stage renal disease and prostate cancer are far more likely to die from an ESRD-related event than prostate cancer. The findings suggest that the 2-year waiting period may no longer be necessary and may even be harmful for patients with low- or intermediate-risk prostate cancer.

• An analysis of 421 adult transplant patients showed a 28% readmission rate, usually due to fluid/electrolyte issues, infection, or rising creatinine. Patients who were discharged earlier had a lower chance of readmission.

• The use of stents in transplant patients does not increase the risk of urinary tract infection in general or of multidrug-resistant UTI in particular.UT

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