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NSS for an RCC in a patient with renal insufficiency after heart transplant because of right ventricular tumor.

Prokopowicz G, Zyczkowski M, Nowakowski K, Bryniarski P, Paradysz A - Cent European J Urol (2013)

Bottom Line: They require maximum doses of immunosuppressive drugs.In the case of patients with initial renal insufficiency the duration of ischaemia of the organ operated on should be minimized, and if possible, surgery should be conducted without clamping the renal pedicle.The surgical treatment of RCC (renal cell carcinoma) in transplant patients does not require any reduction in the amount of the immunosuppressive drugs.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology in Zabrze, Medical University of Silesia in Katowice, Poland.

ABSTRACT
The effect of the immunosuppressive therapy on the development of neoplasms has become the object of an ever increasing interest for clinicians all over the world. The literature on neoplasms development in the course of therapy following transplants has confirmed a considerable increase in the incidence of neoplasms of the skin and lymph nodes. Organ neoplasms developing in patients after transplants are characterized by increased progression, poor cellular diversification and a more unfavorable prognosis than in the general population The aim of the study is to present the case of a nephron-sparing surgery of a renal tumor (NSS) without any intraoperative ischaemia in a 55-year-old female patient with an orthotopic heart transplant and renal insufficiency following a prolonged immune suppression. It is estimated that the patients at the highest risk of neoplasm development are those in the first months after transplant, especially heart transplant. They require maximum doses of immunosuppressive drugs. In the case of patients with initial renal insufficiency the duration of ischaemia of the organ operated on should be minimized, and if possible, surgery should be conducted without clamping the renal pedicle. The surgical treatment of RCC (renal cell carcinoma) in transplant patients does not require any reduction in the amount of the immunosuppressive drugs.

No MeSH data available.


Related in: MedlinePlus

CT–scan: Fairly well–circumscribed mass that was subjected to a non–homogenous post–contrast enhancement and modeling of the renal calyceal–pelvic system.
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Figure 0001: CT–scan: Fairly well–circumscribed mass that was subjected to a non–homogenous post–contrast enhancement and modeling of the renal calyceal–pelvic system.

Mentions: In March 2010, a 55–year–old female patient with an orthotopic heart transplant was admitted to the Department of Urology to undergo surgical treatment for a right–kidney tumor. On the day of admission the patient was given tacrolimus in a 2 x 6 mg dose. The physical examination showed no significant deviations from normal and the family history was non–contributory. The laboratory tests indicated an increased creatinine level up to 185 mcmol/l, which was related to chronic renal failure following the post–transplant therapy with cyclosporine. The heart transplant was conducted in 1999 due to a tumor of the right ventricle and considerable myocardial insufficiency classified as 3rd/4th NYHA degree. The surgery, which used extracorporeal circulation, was uncomplicated. In the post–operative period, a considerable worsening of the function of the transplanted organ had been observed twice due to acute cell rejection, as confirmed by the biopsy results. The regression of the lesions was accomplished with intensive treatment with cytolytic drugs and glucocorticoid therapy. The patient was discharged with an indefinite recommendation to take Cyclosporine (2 x 50 mg), Azathioprine (1 x 200 mg), and Encorton in the maintenance dose (20 mg/day). The excised cardiac tumor was described as a hamartoma originating from the septum and wall of the right ventricle. Within 11 years after the transplant, the patient had developed arterial hypertension, hypercholesterolemia, and chronic renal insufficiency. In February 2010, a two–day episode of hematuria occurred. The ultrasound examination of the abdomen revealed the presence of a 5–cm hyperplastic lesion in the right kidney. The ultrasound findings were confirmed by a CT–scan (Fig. 1), which demonstrated a fairly well–circumscribed mass that was subjected to a non–homogenous post–contrast enhancement and modeling of the renal calyceal–pelvicsystem without any trace of stasis. The patient was qualified to an organ–sparing procedure. The surgery was conducted under general anesthesia. The right kidney was dissected free with a 5–cm in diameter mass visible in its central part. During the operation, a decision was made to resign from clamping the renal vessels in order to reduce the risks of ischemia and aggravation of the insufficiency of the organ operated on. A grayish solid mass encapsulated by a pseudocyst was enucleated (Fig. 2). The cavity remaining after tumor removal was filled with a collagen sponge, which was coated with human coagulation factors (fibrinogen and prothrombin), and hemostatic sutures were applied to the renal parenchyma to obtain complete hemostasis. During the procedure, the patient lost approximately 500 mL of blood. The decrease in the blood morphology parameters was equalized with the transfusion of two units of blood during the surgery and another two units in the subsequent days of convalescence.


NSS for an RCC in a patient with renal insufficiency after heart transplant because of right ventricular tumor.

Prokopowicz G, Zyczkowski M, Nowakowski K, Bryniarski P, Paradysz A - Cent European J Urol (2013)

CT–scan: Fairly well–circumscribed mass that was subjected to a non–homogenous post–contrast enhancement and modeling of the renal calyceal–pelvic system.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921851&req=5

Figure 0001: CT–scan: Fairly well–circumscribed mass that was subjected to a non–homogenous post–contrast enhancement and modeling of the renal calyceal–pelvic system.
Mentions: In March 2010, a 55–year–old female patient with an orthotopic heart transplant was admitted to the Department of Urology to undergo surgical treatment for a right–kidney tumor. On the day of admission the patient was given tacrolimus in a 2 x 6 mg dose. The physical examination showed no significant deviations from normal and the family history was non–contributory. The laboratory tests indicated an increased creatinine level up to 185 mcmol/l, which was related to chronic renal failure following the post–transplant therapy with cyclosporine. The heart transplant was conducted in 1999 due to a tumor of the right ventricle and considerable myocardial insufficiency classified as 3rd/4th NYHA degree. The surgery, which used extracorporeal circulation, was uncomplicated. In the post–operative period, a considerable worsening of the function of the transplanted organ had been observed twice due to acute cell rejection, as confirmed by the biopsy results. The regression of the lesions was accomplished with intensive treatment with cytolytic drugs and glucocorticoid therapy. The patient was discharged with an indefinite recommendation to take Cyclosporine (2 x 50 mg), Azathioprine (1 x 200 mg), and Encorton in the maintenance dose (20 mg/day). The excised cardiac tumor was described as a hamartoma originating from the septum and wall of the right ventricle. Within 11 years after the transplant, the patient had developed arterial hypertension, hypercholesterolemia, and chronic renal insufficiency. In February 2010, a two–day episode of hematuria occurred. The ultrasound examination of the abdomen revealed the presence of a 5–cm hyperplastic lesion in the right kidney. The ultrasound findings were confirmed by a CT–scan (Fig. 1), which demonstrated a fairly well–circumscribed mass that was subjected to a non–homogenous post–contrast enhancement and modeling of the renal calyceal–pelvicsystem without any trace of stasis. The patient was qualified to an organ–sparing procedure. The surgery was conducted under general anesthesia. The right kidney was dissected free with a 5–cm in diameter mass visible in its central part. During the operation, a decision was made to resign from clamping the renal vessels in order to reduce the risks of ischemia and aggravation of the insufficiency of the organ operated on. A grayish solid mass encapsulated by a pseudocyst was enucleated (Fig. 2). The cavity remaining after tumor removal was filled with a collagen sponge, which was coated with human coagulation factors (fibrinogen and prothrombin), and hemostatic sutures were applied to the renal parenchyma to obtain complete hemostasis. During the procedure, the patient lost approximately 500 mL of blood. The decrease in the blood morphology parameters was equalized with the transfusion of two units of blood during the surgery and another two units in the subsequent days of convalescence.

Bottom Line: They require maximum doses of immunosuppressive drugs.In the case of patients with initial renal insufficiency the duration of ischaemia of the organ operated on should be minimized, and if possible, surgery should be conducted without clamping the renal pedicle.The surgical treatment of RCC (renal cell carcinoma) in transplant patients does not require any reduction in the amount of the immunosuppressive drugs.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology in Zabrze, Medical University of Silesia in Katowice, Poland.

ABSTRACT
The effect of the immunosuppressive therapy on the development of neoplasms has become the object of an ever increasing interest for clinicians all over the world. The literature on neoplasms development in the course of therapy following transplants has confirmed a considerable increase in the incidence of neoplasms of the skin and lymph nodes. Organ neoplasms developing in patients after transplants are characterized by increased progression, poor cellular diversification and a more unfavorable prognosis than in the general population The aim of the study is to present the case of a nephron-sparing surgery of a renal tumor (NSS) without any intraoperative ischaemia in a 55-year-old female patient with an orthotopic heart transplant and renal insufficiency following a prolonged immune suppression. It is estimated that the patients at the highest risk of neoplasm development are those in the first months after transplant, especially heart transplant. They require maximum doses of immunosuppressive drugs. In the case of patients with initial renal insufficiency the duration of ischaemia of the organ operated on should be minimized, and if possible, surgery should be conducted without clamping the renal pedicle. The surgical treatment of RCC (renal cell carcinoma) in transplant patients does not require any reduction in the amount of the immunosuppressive drugs.

No MeSH data available.


Related in: MedlinePlus