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Lledo E, Tabbara MM, Alvarez A, Chandar J, González J, Vianna R, Ciancio G. Venous vascular reconstruction of a robotically procured right kidney with two renal veins transplanted into a pediatric recipient. Pediatr Transplant 2024; 28:e14646. [PMID: 37975173 DOI: 10.1111/petr.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/19/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Right versus left kidney donor nephrectomy remains a controversial topic in renal transplantation given the increased incidence of right kidney vascular anomalies and associated venous thrombosis. We present the case of a 3-year-old pediatric recipient with urethral atresia and end-stage kidney disease who received a robotically procured living donor right pelvic kidney with two short same-size renal veins and a short ureter. METHODS We utilized a completely deceased iliac vein system (common iliac vein with both external and internal veins) to extend the two renal veins. Due to the distance between both renal veins, the external iliac vein was anastomosed to the upper hilum renal vein, and the internal iliac vein was anastomosed to the lower hilum renal vein. The donor's short ureter was anastomosed to the recipient's ureter end-to-side. RESULTS The patient had immediate graft function and there were no post-operative complications. Renal ultrasound was unremarkable at 48 hours post-transplant. Serum creatinine was 0.5 mg/dL at 3 months post-transplant. CONCLUSION We demonstrate the successful transplantation of a robotically procured right pelvic donor kidney with two short renal veins using a deceased donor iliac vein system for venous reconstruction without increasing technical complications. This technique of venous reconstruction can be used in right kidneys with similar anatomical variations without affecting graft function.
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Affiliation(s)
- Enric Lledo
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Marina M Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Angel Alvarez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jayanthi Chandar
- Divison of Pediatric Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Javier González
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rodrigo Vianna
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Pal BC, Modi PR, Rizvi SJ, Chauhan R, Kumar S, Gandhi SP, Kute VB, Trivedi HL. Pure retroperitoneoscopic donor nephrectomy in duplication of inferior vena cava: A series of four cases. Urol Ann 2017; 9:335-338. [PMID: 29118534 PMCID: PMC5656957 DOI: 10.4103/ua.ua_59_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Complex vascular anatomy poses a major challenge to the donor surgeon. Here, we have described the technical nuances in retroperitoneoscopic living donor nephrectomy for the left kidney in the situations of a rare vascular anomaly of duplication of inferior vena. Materials and Methods: Between September 2005 and June 2016, 1460 retroperitoneoscopic living donor nephrectomy were carried out in single surgical unit of our institution. Out of these four donors were found to have duplication of inferior vena cava (IVC). We retrospectively analyzed the prospectively collected data of these donors and studied the operative details for managing the duplicated limb of the IVC. Results: The mean age of the donors was 42.5 (range 30–54) years. Mean body mass index was 26.9 (range 25.2–28.6) kg/m2. Mean operative time (defined as between giving skin incision to the skin closure [O. T]), was 230 (range 185–310 min). Mean Warm ischemia time (defined from clamping of the renal artery to the starting of the cold HTK perfusion, [WIT]) was 136 s (range 105–178 s). In two cases, the renal vein could be controlled distal to the duplicated limb. In one case, the duplicated limb was clipped while in another a stapler was used to take a cuff of IVC. Conclusion: Retroperitoneoscopic donor nephrectomy can be performed safely in cases of duplication of IVC. Preoperative computerized tomography angiography with vascular reconstruction and surgical expertise is desirable in carrying out the procedure.
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Affiliation(s)
- Bipin Chandra Pal
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Pranjal R Modi
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Syed Jamal Rizvi
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Rohit Chauhan
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Suresh Kumar
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Shruti P Gandhi
- Department of Radiology and Imaging, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Vivek B Kute
- Department of Nephrology and Transplantation Medicine, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Hargovind L Trivedi
- Department of Nephrology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Modi P. The mini-incision donor nephrectomy is best suited for Indian patients undergoing live donor nephrectomy: against the motion. Indian J Urol 2010; 26:142-4. [PMID: 20535306 PMCID: PMC2878431 DOI: 10.4103/0970-1591.60465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pranjal Modi
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre, Institute of Trans plantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad - 380 016, Gujarat, India
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