Best of AUA 2014: Transplantation/Vascular Surgery

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• Several studies evaluating robotic kidney transplantation suggest the procedure might extend the benefits of minimally invasive surgery to transplant recipients. Simple cooling techniques can be employed to minimize warm ischemia time and limit delayed graft function. Graft and patient outcomes, as well as cost-effectiveness, must be assessed.

• A survey of Canadian senior urology residents showed that a minority intended to pursue a career in transplantation, but almost 80% said their exposure to transplantation was useful.

• Urine protein profiling identified alpha-1-microglobulin and haptoglobin as biomarkers of early allograft rejection.

• Plenary presentations on prostate cancer and renal transplantation demonstrated the need to know how long a patient will live on dialysis or with prostate cancer and use the information to guide clinical decision making. Transplantation confers a low likelihood of transmitting or spreading prostate cancer. Immunosuppressed patients do not have an increased risk of prostate cancer.

• Key messages from a point-counterpoint-session on transplantation: Live donor nephrectomy is safe but must always be performed with caution; live donors may include carefully selected patients with obesity, hypertension, family history of diabetes, and renal stones.

• Presentations at the Urologic Society for Transplantation and Renal Surgery (USTRS) showed that the workup, diagnosis, and treatment of erectile dysfunction in transplant recipients do not differ from the non-transplant patient. Patients may need higher doses of phosphodiesterase-type-5 inhibitors. Use of a penile prosthesis should be pursued with caution. Transplant patients have a high prevalence of hypogonadism, and there is a paucity of data regarding testosterone replacement therapy in patients with end-stage renal disease and kidney transplant recipients.

• Other presentations at the USTRS showed that female kidney transplant recipients have a high rate of successful live births. Vaginal delivery is not precluded by transplantation. The rate of graft loss is no greater in pregnant versus nonpregnant recipients. Mycophenolate mofetil (CellCept) must be avoided because of a risk of birth defects. Prednisone and azathioprine (Imuran, Azasan) appear to be the safest immunosuppressive therapy in pregnancy. Transplantation is not an absolute contraindication to breastfeeding.UT

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