Barba-Abad, J.F. (Javier Fermín)
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- Impact of renal retransplantation on graft and recipient survival(Bok Ediciones Sa, 2011) Romero-Vargas, L. (Luis); Barba-Abad, J.F. (Javier Fermín); Rosell, D. (David); Zudaire-Bergera, J.J. (Juan Javier); Saiz-Sansi, A. (Abel); Pascual-Piedrola, J.I. (Juan Ignacio); Berian-Polo, J.M. (José María); Robles-Garcia, J.E. (José Enrique); Algarra, R. (Rubén); Tolosa-Eizaguirre, E. (Egoitz)The aim of this study was to evaluate the influence of retransplantation in graft and recipient survival. METHODS: We carried out a retrospective study in 419 renal transplants and studied the influence of retransplantation in graft and patient survival. A homogeneity study was performed between the two groups with a Student`s T and a chi-square tests. Graft survival analysis was performed with Kaplan-Meyer and log rank tests. RESULTS: Of 419 transplants, 370 (88.3%) were first transplantations, 45 (10.7%) second transplantations and 4(1%) third ones. Mean follow-up of the whole group was 72.5 months (+/-54.1 SD). There were no differences in follow-up between groups (Mean Follow-up 73.1 months +/-54.4 SD in first transplantations vs. 61.6 months +/-51.2 SD in repeat transplantation. p >0.05). The actuarial graft survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 89% (95% CI: 87-91%) and 84%(95% CI: 82-86%) Vs 88% (95% CI; 83-93%) and 85% (95% CI:i; 80-90%) respectively]. After adjusting for all the heterogeneity variables we still did not find differences on graft survival. The actuarial recipient survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 98% and 96% Vs.97%]. CONCLUSIONS: There are no differences of graft and recipient survival between patients with a first transplantation and those with a repeat one.
- Recipient and donor risk factors for surgical complications following kidney transplantation(2012) Romero-Vargas, L. (Luis); Barba-Abad, J.F. (Javier Fermín); Velis, J.M. (José María); Tienza, A. (Antonio); Robles-Garcia, J.E. (José Enrique); Algarra, R. (Rubén)Objective. The aim of this study was to evaluate recipient and donor risk factors that are related to surgical complications after renal transplantation. Material and methods. In total, 419 kidney transplantations were analysed with regard to the influence of recipient and donor risk factors on the main postoperative surgical complications. Results. The mean follow-up for the entire group was 72.8 months (± 54.2 SD). Vascular complications were independently associated with donor age; and urological complications with recipient age >65 years and cyclosporine rather than tacrolimus therapy. Wound complications were independently associated with recipient age, preoperative dialysis time, recipient body mass index (BMI) and cyclosporine rather than tacrolimus therapy. Collections were independently associated with retransplantation, type 2 diabetes mellitus and wound complications. Overall surgical complications were associated with donor age and delayed graft function. In terms of severity, grade I complications were independently associated with recipient age and surgical revision, grade II with recipient age >50 years, grade III with recipient BMI, and grade IV with donor age. Conclusions. Recipient characteristics are the primary determinants of wound, urological and minor (Clavien grades I, II and III) complications; however, graft or donor characteristics are the primary risk factors for vascular, overall and major (Clavien grade IV) surgical complications.
- Complications of kidney transplantation with grafts from expanded criteria donors(2012) Barba-Abad, J.F. (Javier Fermín); Rosell, D. (David); Zudaire-Bergera, J.J. (Juan Javier); Pascual-Piedrola, J.I. (Juan Ignacio); Berian-Polo, J.M. (José María); Robles-Garcia, J.E. (José Enrique)Purpose: The limited availability of kidneys for transplantation has been addressed by expanding the criteria for allowing a donor kidney to be transplanted, but this tendency may cause suboptimal kidneys to be implanted and could be associated with greater risk of complications. Methods: A retrospective study of 407 kidney transplantations was done to compare complications of transplantation with non-expanded (n = 244) and expanded criteria donors (n = 163). Expanded criteria donors were donors older than 60 years, or donors aged 50–60 years who had ≥2 of the following risk factors: hypertension, diabetes mellitus (type 2), creatinine >1.5 mg/dL, or death caused by stroke. Results: Compared with transplant recipients from non-expanded criteria donors, transplant recipients from expanded criteria donors had significantly greater frequency of graft loss, delayed graft function, pneumonia, overall surgical complications, early reoperation, wound eventration, hydronephrosis, postoperative hemorrhage, and wound infection. When analyzing surgical complications types, a significant greater frequency of urologic, wound, vascular, early and late surgical complications was found. In terms of severity, expanded donor criteria transplantation was related to Clavien I, III, and IV complications. Conclusions: Transplantation of kidneys from expanded criteria donors is associated with a significant higher risk of medical and surgical complications than kidneys from non-expanded criteria donors.
- Adrenalectomía laparoscópica por metástasis metácrona. Experiencia en 12 casos(Elsevier España, 2010) Romero-Vargas, L. (Luis); Barba-Abad, J.F. (Javier Fermín); Rosell, D. (David); Rincon-Mayans, A. (Anibal); Pascual-Piedrola, J.I. (Juan Ignacio); Tolosa-Eizaguirre, E. (Egoitz)To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. MATERIAL AND METHODS: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. RESULTS: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5 cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. CONCLUSIONS: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery.
- Edad del donante y su influencia en la supervivencia del injerto(Elsevier España, 2010) Barba-Abad, J.F. (Javier Fermín); Rosell, D. (David); Rincon-Mayans, A. (Anibal); Zudaire-Bergera, J.J. (Juan Javier); Pascual-Piedrola, J.I. (Juan Ignacio); Berian-Polo, J.M. (José María); Robles-Garcia, J.E. (José Enrique); Tolosa-Eizaguirre, E. (Egoitz)INTRODUCTION: In 2007 in Spain 43% of donors were older than 60 years. This produces a worse graft quality and probably a worse survival. OBJECTIVE: Our objective is to analyze the influence of donor age on graft survival. MATERIAL AND METHODS: We analyze retrospectively 216 renal consecutive transplants realized between 2000 and 2008. A univaried and multivaried study (Cox regression) was performed and Kaplan-Meyer test with log rank for graft survival. RESULTS: Follow-up mean of 40 months (+/-33,4 SD). The univaried analysis of graft survival showed that donor age had a significative influence on graft survival. (OR=1,03; 95% CI 1,01-1,05) (p: 0,009). Studying the relation between donor and recipient age we find an inverse correlation (Pearson's Correlation: 0,55. p<0,0001), but there are significative differences after the adjustment for recipient age. (OR: 1,02; 95% CI 1,01-1,04) (p: 0,04). Optimal cut-point value determined by the ROC analysis was 60 years. The graft survival of donors over 60 years is 79% (95% CI; 74-84%) and 71% (95% CI; 65-77%) at 3 and 5 years in contrast with 94% (95% CI; 94-96%) and 90% (95% CI; 88-92 in donors under 60. (p: 0,002). The multivaried study of the influential factors on graft survival reveals that donor age dichotomized in older or younger than 60, the presence of a surgical immediate reintervention and a delayed graft function were independent influence factors. CONCLUSIONS: Donor age over 60 years has a negative and independent prognostic influence on graft survival.
- ¿Existe un intervalo de tiempo de isquemia fría seguro para el injerto renal?(Elsevier, 2011) Barba-Abad, J.F. (Javier Fermín); Rosell, D. (David); Zudaire-Bergera, J.J. (Juan Javier); Tienza, A. (Antonio); Pascual-Piedrola, J.I. (Juan Ignacio); Berian-Polo, J.M. (José María); Robles-Garcia, J.E. (José Enrique)Objective: It is aimed to characterize the true relationship of the cold ischemia time (CIT) with graft survival and with the principal post-transplantation events.aterial and methods: We analyzed 378 kidney transplants, studying the relationship of the CIT with graft survival using a univariate analysis according to the COX model and seeking the optimum cutoff according to the Kaplan-Meier method and log-rank test. The relationship between CIT and the principal events of the post-transplant was studied using the binary logistic regression. Results: The mean follow-up of all the group was 77.8 months (± 51 SD) and the mean CIT was 14.8 hours (± 5.1 SD). The univariate analysis revealed that the CIT was not related with the graft survival as a continuous variable (OR = 1.04; 95% CI: 0.9-1.08; p > 0.05). On establishing the cutoff at 18 hours, we found differences in the actuarial survival. Survival at 5 years was 91% with CIT < 18 h versus 84% with CIT >18 h. Each hour of cold ischemia increased risk of delay in the graft function by 10% (OR = 1.1; 95% CI: 1.05-1.15; p < 0.001) and also conditioned a greater incidence of acute rejection (41.5% vs. 55.3%; p = 0.02) and less time to the first rejection episode (72.6 days ± 137 vs. 272.2 days ± 614.8; p = 0.023) after 18 hours. The CIT did not seem to be related (p < 0.05) with the rest of the post-transplantation events, such as surgical complications or hospital admissions. Conclusions: In our experience, cold ischemia under 18 hours does not seem to negatively affect graft survival.
- Adenoma nefrogénico prostático. A propósito de un caso(2011) Romero, L.M. (L.M.); Barba-Abad, J.F. (Javier Fermín); Tienza, A. (Antonio); Panizo, A. (Ángel); Berian-Polo, J.M. (José María); Algarra, R. (Rubén)
- Variante plasmocitoide del carcinoma urotelial: a proposito de un caso(Gobierno de Navarra. Departamento de Salud, 2013) Barba-Abad, J.F. (Javier Fermín); Zudaire-Bergera, J.J. (Juan Javier); Velis, J.M. (José María); Tienza, A. (Antonio); Queipo, F.J. (Francisco Javier); Sola, J.J. (Jesús Javier)Plasmacytoid urothelial carcinoma is an extremely rare pathological finding. We report our experience of one case. A 60 year old male with hematuria of two years evolution, with frequency and dysuria. A tumor was found and he received surgical treatment by TURB at first. The pathology result was a plasmacytoid urothelial carcinoma. Subsequently a radical cystectomy with urinary diversion was performed. The patient received follow-up until his death.
- Nefrectomía parcial laparoscópica. Análisis de los primeros 30 casos de nuestra serie y revisión de la literatura(Elsevier España, 2010) Romero-Vargas, L. (Luis); Barba-Abad, J.F. (Javier Fermín); Rincon-Mayans, A. (Anibal); Zudaire-Bergera, J.J. (Juan Javier); Pascual-Piedrola, J.I. (Juan Ignacio); Tolosa-Eizaguirre, E. (Egoitz)Objective: Our goal is to analyze the surgical and clinicopathological results of our first 30 laparoscopic partial nephrectomies (LPN) performed consecutively and correlate the results with the literature. Material and methods: This is a cases series, with 30 patients (20 men and 10 women) operated between 2006 and 2008. We assessed the clinicopathological factors and complications. The mean and median follow-up was 25 and 5 months. Results: Resected tumors had an average size of 2.4 cm. 60% of the tumors were malignant. The pathological stage was pT1 in 100% of cases (47% grade I, 53% Fuhrman grade II). Surgical margins were positive in 3 cases, switching to open surgery. Intraoperative bleeding was 74.66 cc (35.7±SD) and 70 cc of mean and median. The mean operative time was 214.4min (±69) and ischemia time of 31.3min (±13.8). Conclusions: Our results are similar to those reported in the literature, except for positive margins and conversion attributable to the learning curve.
- Association of crossed renal ectopia and aortic aneurism. Case report(Bok Ediciones S.A., 2010) Romero-Vargas, L. (Luis); Barba-Abad, J.F. (Javier Fermín); Rosell, D. (David); Rincon-Mayans, A. (Anibal); Pascual-Piedrola, J.I. (Juan Ignacio); Robles-Garcia, J.E. (José Enrique); Tolosa-Eizaguirre, E. (Egoitz)OBJECTIVE: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional. METHODS: We present our case and perform a bibliographic review. RESULTS: To date and in our knowledge , seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia. CONCLUSIONS: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen.