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Meinders AM, Knight R, Eagar TN, Hobeika M, Podder H, Gaber AO, Yi SG. Deceased donor vein extension grafts for right living donor kidney transplantation. Clin Transplant 2023; 37:e14963. [PMID: 36938669 DOI: 10.1111/ctr.14963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION In an effort to maximize living donor kidney utilization, we describe the use of deceased donor vein extension grafts for right-sided living donor kidneys and report our single-center experience using this technique. METHODS A retrospective review of kidney transplant recipients (KTR) who received a right living donor kidney with deceased donor vein extension graft. Recipient demographics, postoperative graft function, and surgical complications were reviewed. Living donor nephrectomies were performed laparoscopically. Vein grafts were obtained from recent deceased donor procurements. End-to-end anastomosis of the graft to the renal vein was performed prior to implantation. RESULTS Thirty-eight KTR received a right kidney transplant with deceased donor extension grafts. The median recipient age and BMI were 53.0 years and 29.3 kg/m2 . Total 71% were male. Ninety-five percent of grafts displayed immediate graft function, with two recipients requiring temporary dialysis due to anaphylaxis from induction therapy. Median serum creatinine at two weeks was 1.6 mg/dL and at three months was 1.5 mg/dL. There were no graft thromboses. CONCLUSION Utilization of deceased donor extension grafts for short right renal veins is a simple technique that expands the donor pool for living donor renal transplantation. Our experience resulted in no technical complications and excellent early graft function.
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Affiliation(s)
- Andrea M Meinders
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Richard Knight
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Todd N Eagar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Mark Hobeika
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Hemangshu Podder
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Stephanie G Yi
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
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Navarro Del-Río E, Parmentier de-León C, Chávez Villa M, Carpinteyro Espín P, Quintero-Quintero MJ, Vilatobá M, Contreras AG, Cruz Martínez R. Use of Iliac Allograft from Cadaveric Donor as a Rescue Technique in Living Donor Kidney Transplant: Two Case Reports. Transplant Proc 2020; 52:1102-1105. [PMID: 32204898 DOI: 10.1016/j.transproceed.2020.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A short right renal vein (RRV) remains a challenge for renal transplant surgery, especially in the living donor. Different techniques exist to obtain an RRV with a suitable length in cadaveric donor; however, in living donors the options are limited. MATERIAL AND METHODS We present 2 living kidney transplants in which we obtained a very short RRV, making the implantation very difficult. We describe our technique to overcome this problem by using cadaveric iliac vessels retrieved from previous cadaveric donations and preserved at 4°C in histidine-tryptophan-ketoglutarate (HTK) solution, without intraoperative or postoperative complications. We complied with the Helsinki Congress and the Istanbul Declaration regarding the donor source. RESULTS In both cases, kidney grafts had optimal primary function, with good creatinine clearance after transplant and good patency of vascular anastomosis by Doppler ultrasounds. CONCLUSIONS We believe the use of cadaveric vessel grafts in living donor kidney transplant is a valuable resource as a rescue tool in emergency situations like the ones being presented in this article in order to avoid discarding a kidney graft with damage or short vessels. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- Estephanía Navarro Del-Río
- Transplant Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Catherine Parmentier de-León
- Transplant Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Mariana Chávez Villa
- Transplant Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Paulina Carpinteyro Espín
- Transplant Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Marco José Quintero-Quintero
- Transplant Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Mario Vilatobá
- Transplant Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Alan G Contreras
- Transplant Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Rodrigo Cruz Martínez
- Transplant Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico.
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Lu T, Yi SG, Bismuth J, Knight RJ, Gaber AO, Bechara CF. Short- and midterm results for internal jugular vein extension for short right renal vein kidney transplant. Clin Transplant 2018; 32:e13312. [PMID: 29888810 DOI: 10.1111/ctr.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 11/27/2022]
Abstract
Renal transplantation remains the definitive treatment for end-stage renal disease (ESRD). The shorter renal vein in right donor nephrectomies is associated with higher incidence of technical failure. We present here our experience with autologous internal jugular vein (IJV) conduits to facilitate living-donor transplants. Six patients underwent right, living-donor kidney transplant with simultaneous IJV harvest over a 1-year period. All had bilateral jugular duplex scans preoperatively and were placed on aspirin 81 mg postoperatively. Patient demographics, comorbidities, and laboratories were retrospectively queried. Postoperative follow-up and examination were performed per institutional protocol. The mean age and BMI were 51 ± 4.6 years and 30 ± 1.4 kg/m2 , respectively. An average 4.5 ± 0.5 cm of IJV was taken, and anastomosed exsitu, end to end to the renal vein. One patient developed a perinephric hematoma requiring reexploration and another expired during follow-up from septic shock of unknown etiology; there were no harvest site complications or deep vein thrombosis. All had immediate and stable graft function at 3.8 ± 1.7 (range: 0.7-11.3) months follow-up. Mean serum creatinine and estimated glomerular filtration rate were 1.3 ± 0.1 mg/dL and 55 ± 2.4 mL/min/1.73 m2 , respectively. Internal jugular vein extension of short right renal veins for kidney transplant is a viable technique for ESRD patients with promising results.
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Affiliation(s)
- Tony Lu
- Division of Vascular and Endovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Stephanie G Yi
- Division of Transplant Surgery, Houston Methodist J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Jean Bismuth
- Division of Vascular and Endovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Richard J Knight
- Division of Transplant Surgery, Houston Methodist J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - A Osama Gaber
- Division of Transplant Surgery, Houston Methodist J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Carlos F Bechara
- Division of Vascular and Endovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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Shimizu T, Omoto K, Iida S, Inui M, Tsukuda F, Toma H, Iizuka J, Ishida H, Tanabe K. Living Related Renal Transplantation Using a Saphenous Vein Graft: A Case Report. Transplant Proc 2018; 50:2562-2564. [PMID: 30173850 DOI: 10.1016/j.transproceed.2018.03.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
We report a case of living related renal transplantation that used the recipient's saphenous vein as a graft to extend the length of the right donor renal vein. A 41-year-old woman underwent ABO-incompatible living related renal transplantation from her 74-year-old mother in November 2014. A retroperitoneal laparoscopic right donor nephrectomy was performed, because the right kidney showed a cyst on preoperative computed tomography. As the right kidney after donor nephrectomy had a short renal vein and the kidney was large at 280 g, anastomosis with the external iliac vein was difficult. Therefore, we obtained the recipient's 15-cm-long right saphenous vein and created a 1 cm saphenous vein graft. We anastomosed 1 side of the saphenous vein graft to the allograft renal vein in bench surgery and performed end-to-side anastomosis of the other end to the recipient's external iliac vein. The allograft renal artery was used to perform end-to-end anastomosis to the recipient's internal iliac artery. Allograft kidney function was good after transplantation. When the longer axis of the renal graft vein is short, as in the right kidney, a saphenous vein graft may be useful.
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Affiliation(s)
- T Shimizu
- Department of Transplant Surgery, Toda Chuo General Hospital, Saitama, Japan; Department of Urology, Toda Chuo General Hospital, Saitama, Japan; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
| | - K Omoto
- Department of Transplant Surgery, Toda Chuo General Hospital, Saitama, Japan
| | - S Iida
- Department of Urology, Toda Chuo General Hospital, Saitama, Japan
| | - M Inui
- Department of Urology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - F Tsukuda
- Department of Urology, Edogawa Hospital, Tokyo, Japan
| | - H Toma
- Department of Urology, Toda Chuo General Hospital, Saitama, Japan
| | - J Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Che H, Li X, Yang M, Zhang P, Jing P, Zhang J. Fax Extension of the Right Renal Vein With a Remodeled Receptor Saphenous Vein in a Living-Donor Kidney Transplant: A Case Report. EXP CLIN TRANSPLANT 2014; 14:224-6. [PMID: 25343254 DOI: 10.6002/ect.2014.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The right kidney may be chosen for donor safety as the donor kidney in a living renal transplant. However, the short length of the right renal vein may increase technical difficulties and affect the implanted graft. We report a method that uses the remodeled receptor saphenous vein to reconstruct and extend the transplanted renal vein.
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Affiliation(s)
- Haijie Che
- From the Department of Vascular Surgery, YanTai Yuhuangding Hospital, China
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