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Han DS, Johnson JP, Schulster ML, Shah O. Indications for and results of renal autotransplantation. Curr Opin Nephrol Hypertens 2023; 32:183-192. [PMID: 36683544 DOI: 10.1097/mnh.0000000000000860] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW To understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. RECENT FINDINGS Renal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) - though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists. SUMMARY In experienced hands, renal autotransplantation is a reasonable treatment approach for complex and refractory renal vascular disease, Loin-Pain Hematuria Syndrome, ureteral strictures and trauma, upper urinary tract malignancy, and stone disease in highly select patients.
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Affiliation(s)
- David S Han
- Columbia University Irving Medical Center, Department of Urology
| | - Jeffrey P Johnson
- Weill Cornell Medical College, Department of Urology, New York, New York, USA
| | | | - Ojas Shah
- Columbia University Irving Medical Center, Department of Urology
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Wacker C, Schiffer M, Richterstetter M, Opgenoorth M, Apel H. Kidney Autotransplantation in a 78-Year-Old Man with Proximal Ureteral Urothelial Carcinoma after Living Donor Nephrectomy. Urol Int 2020; 104:994-996. [PMID: 32731222 DOI: 10.1159/000509445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022]
Abstract
Six years after living donor nephrectomy to his daughter, the 78-year-old donor presented to the emergency room with anuria for approximately 12 h. Only arterial hypertension, mildly reduced kidney function (eGFR 54 mL/min), and benign prostatic hyperplasia were known as preexisting medical conditions. In sonography, hydronephrosis III° was visible in the right single kidney. Ureterorenoscopy revealed an occlusive tumor in the right proximal ureter, which was treated via double J stent. Biopsy showed focal invasive papillary urothelial carcinoma of G2 high grade. Preoperative staging did not show any signs of lymph node or distant metastases. For therapeutic options, nephroureterectomy with consecutive need for dialysis was discussed versus partial ureteral resection with in situ ureteral reconstruction versus nephroureterectomy with partial ureteral resection and kidney autotransplantation. Eventually, laparoscopic right nephroureterectomy was performed with back-table preparation and tumor resection, followed by ipsilateral autotransplantation. The patient developed postsurgical acute kidney failure due to ischemia/reperfusion with a maximum serum Cr of 5.66 mg/dL (eGFR 10 mL/min), which quickly resolved. The papillary invasive urothelial carcinoma was graded pT1 pTis G2 high grade R0. Regular follow-ups showed no sign for cancer recurrence in computer tomography or cystoscopy; serum Cr was at 1.87 mg/dL (eGFR 53) 12 months after surgery.
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Affiliation(s)
- Caroline Wacker
- Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Erlangen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Mirian Opgenoorth
- Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Erlangen, Germany
| | - Hendrik Apel
- Department of Urology, University Erlangen-Nürnberg, Erlangen, Germany
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Mhaske SM, Patil B, Patwardhan SK, Gopalakrishnan G, Shelke UR, Pamecha YG. Outcome following renal autotransplantation in renal artery stenosis. Urol Ann 2019; 11:46-52. [PMID: 30787570 PMCID: PMC6362799 DOI: 10.4103/ua.ua_39_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction With significant advances in the area of interventional radiology, angioplasty and stenting have become preferred first-line treatment in patients with significant renal artery stenosis. However, not all patients have favorable anatomy to undergo minimally invasive treatments, and reconstruction of the renal artery is an option. In select cases, either improved renal function or maintenance of existing function and sometimes resolution of hypertension can follow surgical treatment. Material and Methods This was a prospective observational study conducted from August 2010 to June 2016. Patients <45 years of age with uncontrolled hypertension secondary to renovascular hypertension (RVH) and refractory to medical management and renal arterial disease unfavorable for percutaneous intervention were included in the study. All patients were evaluated thoroughly using computed tomography angiography and diethylenetriaminepentaacetic acid renal scan. Patients underwent autotransplantation either into the right or left iliac fossa. Some kidneys required bench reconstruction of the renal artery and/or its branches before being implanted into either iliac fossa. Results Nine patients were included in the study. The mean age was 27 years. Seven were males and two were females. Five patients had bilateral renal artery stenosis. After autotransplantation, initially five patients became free of antihypertensive medicines, but on the follow-up, two patients showed rising trend of blood pressure. The evaluation revealed narrowing at anastomosis site in both patients with salvageable kidney function in one patient. Angioplasty with stenting was done in this patient while the second patient underwent secondary nephrectomy. At 2 years of follow-up, four patients required no antihypertensive medicines. Conclusion Autotransplantation can be a successful treatment of severe RVH and should be considered in patients with renal arterial disease unfavorable for percutaneous intervention.
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Affiliation(s)
- Sunil M Mhaske
- Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Bhushan Patil
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sujata K Patwardhan
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Umesh Ravikant Shelke
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Yash G Pamecha
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Harsha B, Manikandan R, Dorairajan L, Pottakkat B, K S. A case of renal artery and multiple splenic artery aneurysms managed by heterotopic renal autotransplantation with splenectomy and proximal splenorenal shunt. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_24_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alameddine M, Moghadamyeghaneh Z, Yusufali A, Collazo AM, Jue JS, Zheng I, Morsi M, Prakash NS, Gonzalez J. Kidney Autotransplantation: Between the Past and the Future. Curr Urol Rep 2018; 19:7. [PMID: 29399714 DOI: 10.1007/s11934-018-0749-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The practice of kidney autotransplantation (KAT) has become an increasingly favorable approach in the treatment of certain renovascular, ureteral, and malignant pathologies. Current KAT literature describes conventional open procedures, which are associated with substantial risks. We sought to compare previously reported outcomes, evaluate common surgical indications, and assess associated risks and benefits of current KAT methods. A thorough evaluation and review of the literature was performed with the keywords "autologous transplantation" and "kidney." RECENT FINDINGS Early outcomes of robotic KAT are encouraging and have been associated with fewer complications and shorter hospital stay, but require robotic technique proficiency. KAT is an important method to manage selected complex urological pathologies. Robotic KAT is promising. Nevertheless, future studies should utilize larger patient cohorts to better assess the risks and benefits of KAT and to further validate this approach.
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Affiliation(s)
- Mahmoud Alameddine
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA.
| | - Zhobin Moghadamyeghaneh
- Department of Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Ali Yusufali
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Alexa Marie Collazo
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Joshua S Jue
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Ian Zheng
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Mahmoud Morsi
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | | | - Javier Gonzalez
- Hospital Central de la Cruz Roja, Universidad Alfonso X El Sabio, Madrid, Spain
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Ruiz M, Hevia V, Fabuel JJ, Fernández AA, Gómez V, Burgos FJ. Kidney autotransplantation: long-term outcomes and complications. Experience in a tertiary hospital and literature review. Int Urol Nephrol 2017; 49:1929-1935. [PMID: 28828690 DOI: 10.1007/s11255-017-1680-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze indications, surgical technique, complications and long-term outcomes of kidney autotransplantation (KAT) after 26-year experience at a single institution. MATERIALS AND METHODS A retrospective observational study of patients who underwent KAT at our institution (January 1990-December 2016) was carried out. Data collected included indications, surgical technique, complications (Clavien-Dindo), hospital stay and long-term outcomes. Literature review was performed through MEDLINE and ClinicalKey databases including "kidney," "renal," "autotransplantation" and "autograft." RESULTS Fifteen patients underwent a KAT, with a mean age of 41 years (range 34-59). Indications were vascular abnormalities in 8 cases and ureteral injury in 7. Nephrectomy was performed through laparoscopy in 2 cases (13.3%) and open in 13 (86.7%). Vascular grafts to reperfuse the kidney were used in 8 patients, and ureteral reimplantation was performed in 11 cases. Mean hospital stay was 9.1 days (range 3-20). Seven patients (46.7%) developed postoperative complications: 6 minor (Clavien I-II) and 1 major (Clavien III). After a mean follow-up of 73.1 months (range 7-312), 80% of the patients have a functioning graft. Most common indication reported in the literature is ureteral stricture, especially in the most recent years. Graft survival is variable, and complications are frequent, but usually minor. CONCLUSIONS KAT is an effective treatment for complex ureteral lesions and kidney vascular abnormalities, with good results in the long term. Surgical complications are frequent, but usually minor. As a challenging surgery, it should be performed by experienced kidney transplant surgeons. Complex and proximal ureteral injuries are nowadays the main indication of this procedure.
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Affiliation(s)
- Mercedes Ruiz
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
| | - Vital Hevia
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain.
| | - Jose-Javier Fabuel
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
| | - Alvaro-Amancio Fernández
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
| | - Victoria Gómez
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
| | - Francisco-Javier Burgos
- Urology Department, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Ctra Colmenar km 9,100, 28034, Madrid, Spain
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Moghadamyeghaneh Z, Hanna MH, Fazlalizadeh R, Obi Y, Foster CE, Stamos MJ, Ichii H. A Nationwide Analysis of Kidney Autotransplantation. Am Surg 2017. [PMID: 28228203 DOI: 10.1177/000313481708300216] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are limited data regarding outcomes of patients underwent kidney autotransplantation. This study aims to investigate outcomes of such patients. The nationwide inpatient sample database was used to identify patients underwent kidney autotransplantation during 2002 to 2012. Multivariate analyses using logistic regression were performed to investigate morbidity predictors. A total of 817 patients underwent kidney autotransplantation from 2002 to 2012. The most common indication of surgery was renal artery pathology (22.7%) followed by ureter pathology (17%). Overall, 97.7 per cent of operations were performed in urban teaching hospitals. The number of procedures from 2008 to 2012 were significantly higher compared with the number of them from 2002 to 2007 (473 vs 345, P < 0.01). The overall mortality and morbidity of patients were 1.3 and 46.2 per cent, respectively. The most common postoperative complications were transplanted kidney failure (10.7%) followed by hemorrhagic complications (9.7%). Obesity [adjusted odds ratio (AOR): 9.62, P < 0.01], fluid and electrolyte disorders (AOR: 3.67, P < 0.01), and preoperative chronic kidney disease (AOR: 1.80, P = 0.03) were predictors of morbidity in patients. In conclusion, Kidney autotransplantation is associated with low mortality but a high morbidity rate. The most common indications of kidney autotransplantation are renal artery and ureter pathologies, respectively. A kidney transplant failure rate of 10.7 per cent was observed in patients with kidney autotransplantation. The most common postoperative complication was hemorrhagic in nature.
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Steffens J, Humke U, Alloussi S, Ziegler M, Siemer S. Partial nephrectomy and autotransplantation with pyelovesicostomy for renal urothelial carcinoma in solitary kidneys: a clinical update. BJU Int 2007; 99:1020-3. [PMID: 17309555 DOI: 10.1111/j.1464-410x.2007.06753.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the indications and outcomes after partial nephrectomy and renal autotransplantation for urothelial cancer in solitary kidneys, with special attention to the ease of endoscopic tumour control after pyelovesicostomy. PATIENTS AND METHODS In all, 978 records of three institutions were reviewed for patients undergoing partial nephrectomy between January 1990 and December 2000. Ex vivo organ-preserving surgery was used in selected patients with a solitary kidney and localized pelvic or calyceal tumour. Autotransplantation was established using a pyelovesicostomy. The follow-up included ultrasonography, pelvi-cystoscopy, urine cytology, computed tomography, renal functional evaluation and video-urodynamics. The study included four patients aged 52-56 years, with a follow-up of 6-14 years. RESULTS The histopathological status was pT1G2R0 in two and pT1G1R0 in the other two patients. One of them had an additional papilloma in the upper ureter. All patients entered a protocol of mitomycin/bacille Calmette-Guérin instillation therapy after surgery. The patients are currently alive with no recurrences. There is stable kidney function despite vesico-renal reflux, and normal bladder function with no subvesical obstruction. CONCLUSIONS Partial nephrectomy and renal autotransplantation for renal urothelial cancer in solitary kidneys is feasible, but should only be used in the rarest cases, and for the most selective indications. Dialysis and renal replacement can be avoided. Pyelovesicostomy allows effective chemotherapy instillation therapy, and easy and secure urothelial cancer control of the upper urinary tract.
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Affiliation(s)
- Joachim Steffens
- Department of Urology, St Antonius Hospital, Eschweiler, and University of Saarland, Hombérg/Saar, Germany.
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Abstract
Surgical techniques in renal transplantation are standardized and have remained basically unchanged for the last 50 years. A limited pool of donor organs is still an unsolved problem. Therefore, marginal organs are also used. Sophisticated techniques are used in children and in cases with vascular problems or complications. Laparoscopic techniques are emerging in renal transplantation. The article provides an overview on current technical standards of renal transplantation and potential surgical and urological complications. We report the results of our own renal transplantation program with special emphasis on vascular techniques, pediatric transplantation, and the management of complications. Special case reports are included.
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Affiliation(s)
- W Werner
- Klinik und Poliklinik für Urologie, Friedrich-Schiller-Universität, Jena.
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Ysa-Figueras A, Clará A, de la Fuente-Sánchez N, Roig-Santamaría L, Miralles M, Santiso-Fernández A, Martínez-Cercos R, Vidal-Barraquer Mayol F. Cirugía ex vivo y autotrasplante en el tratamiento de aneurismas de arteria renal. ANGIOLOGIA 2003. [DOI: 10.1016/s0003-3170(03)74808-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Murphy JT, Borman KR, Dawidson I. Renal autotransplantation after horseshoe kidney injury: a case report and literature review. THE JOURNAL OF TRAUMA 1996; 40:840-4. [PMID: 8614094 DOI: 10.1097/00005373-199605000-00031] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We present a patient with lap seatbelt trauma to a previously unsuspected horseshoe kidney. Preoperative single film intravenous pyelography did not suggest the presence of this renal anomaly or define the extent of renal injury. Because of the severity of the injury, nephrectomy was life-saving, but inadvertently rendered the patient anephric. Recognition of horseshoe kidney anatomy, microvascular back-bench reconstruction, and renal autotransplantation allowed the salvage of both the patient and her renal function.
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Affiliation(s)
- J T Murphy
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, 75235, USA
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Lindblad B, Bergqvist D, Kristiansen P. Bilateral renal autotransplantation with direct pyelocystostomy in a patient with frequent disabling nephroureterolithiasis. Case report. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1993; 27:413-4. [PMID: 8290923 DOI: 10.3109/00365599309180455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case with disabling nephroureterolithiasis, initially most frequent from the right side, later also from the left kidney, is presented. Conservative treatment did not improve the condition and bilateral renal autotransplantation with pyelocystostomies was performed. Follow-up so far has been uneventful. In highly selected cases this is a useful alternative treatment.
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Affiliation(s)
- B Lindblad
- Department of Surgery, Lund University, Malmö General Hospital, Sweden
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Brekke IB, Sødal G, Jakobsen A, Bentdal O, Pfeffer P, Albrechtsen D, Flatmark A. Fibro-muscular renal artery disease treated by extracorporeal vascular reconstruction and renal autotransplantation: short- and long-term results. EUROPEAN JOURNAL OF VASCULAR SURGERY 1992; 6:471-6. [PMID: 1397339 DOI: 10.1016/s0950-821x(05)80619-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over a 16-year period (1973-1989), 63 renal autotransplants were performed in 59 patients for fibro-muscular dysplasia (FMD) with renal artery stenoses (42 kidneys) or aneurysms (21 kidneys). About two-thirds of the autotransplants were performed before percutaneous transluminal angioplasty (PTA) was established for clinical use. However, vascular disease at a site or type not suitable for PTA was present in 57 (90%) of the kidneys. Hypertension was the leading symptom in 56 patients, including four in whom renal autotransplantation was performed as an emergency for acute renal artery occlusion or malignant hypertension. Blood pressure returned to normal or improved in 51 (91%) and remained unchanged in five patients (9%) following autotransplantation. Three patients with renal artery aneurysm in whom haematuria and loin pain were the indications for treatment, became asymptomatic following surgical intervention. Bilateral renal autotransplantation was performed synchronously in one and sequentially in three patients. There were no operative deaths, but two kidneys were lost postoperatively in two 2-year-old children owing to renal vascular thrombosis. In the follow-up period (mean 4.3 years), one additional kidney was lost at 3 months owing to progressive FMD. Blood pressure and renal function remained stable in all other patients. Based on the excellent results achieved in this series, it is concluded that extracorporeal vascular repair and renal autotransplantation is a safe procedure for the patient as well as the kidney affected by FMD. The procedure is advocated as an alternative to in situ reconstruction in patients with renal artery disease not accessible to PTA, such as aneurysms and complex branch renal artery stenoses.
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Affiliation(s)
- I B Brekke
- Department of Surgery B, National Hospital, Oslo, Norway
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Søreide O. Abdominal aortic aneurysm surgery--by whom? EUROPEAN JOURNAL OF VASCULAR SURGERY 1990; 4:333-4. [PMID: 2397770 DOI: 10.1016/s0950-821x(05)80861-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- O Søreide
- Surgical Department B, National Hospital, Oslo, Norway
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