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Sageshima J, Chandar J, Chen LJ, Shah R, Al Nuss A, Vincenzi P, Morsi M, Figueiro J, Vianna R, Ciancio G, Burke GW. How to Deal With Kidney Retransplantation-Second, Third, Fourth, and Beyond. Transplantation 2022; 106:709-721. [PMID: 34310100 DOI: 10.1097/tp.0000000000003888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Kidney transplantation is the best health option for patients with end-stage kidney disease. Ideally, a kidney transplant would last for the lifetime of each recipient. However, depending on the age of the recipient and details of the kidney transplant, there may be a need for a second, third, fourth, or even more kidney transplants. In this overview, the outcome of multiple kidney transplants for an individual is presented. Key issues include surgical approach and immunologic concerns. Included in the surgical approach is an analysis of transplant nephrectomy, with indications, timing, and immunologic impact. Allograft thrombosis, whether related to donor or recipient factors merits investigation to prevent it from happening again. Other posttransplant events such as rejection, viral illness (polyomavirus hominis type I), recurrent disease (focal segmental glomerulosclerosis), and posttransplant lymphoproliferative disease may lead to the need for retransplantation. The pediatric recipient is especially likely to need a subsequent kidney transplant. Finally, noncompliance/nonadherence can affect both adults and children. Innovative approaches may reduce the need for retransplantation in the future.
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Affiliation(s)
- Junichiro Sageshima
- Division of Transplant Surgery, Department of Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Jayanthi Chandar
- Division of Pediatric Kidney Transplantation, Department of Pediatrics, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Linda J Chen
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Rushi Shah
- Surgical Transplant Fellow, Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Ammar Al Nuss
- Surgical Transplant Fellow, Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Paolo Vincenzi
- Surgical Transplant Fellow, Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Mahmoud Morsi
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Jose Figueiro
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Rodrigo Vianna
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
- Division of Liver and GI Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Gaetano Ciancio
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - George W Burke
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
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de Cerqueira JBG, de Oliveira CMC, Silva BGB, Santos LCO, Fernandes AG, Fernandes PFCBC, Maia EL. Kidney Transplantation Using Gonadal Vein for Venous Anastomosis in Patients With Iliac Vein Thrombosis or Stenosis: A Series of Cases. Transplant Proc 2018; 49:1280-1284. [PMID: 28735994 DOI: 10.1016/j.transproceed.2017.02.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Kidney transplantation is the treatment of choice for patients with end-stage renal disease. The standard surgery uses the recipient's iliac vessels for vascular anastomosis. Thrombosis and/or stenosis of the iliac vein, which are possible complications of multiple vascular access points for dialysis, can be detected intraoperatively, constituting a surgical challenge. An infrequently reported option is the use of the gonadal vein. OBJECTIVES This study aims to evaluate the outcomes of venous anastomosis in the gonadal vein in patients with iliac vein thrombosis and/or stenosis submitted to kidney transplantation. METHODS We reviewed the records of five adult recipients with iliac vein thrombosis and/or stenosis detected intraoperatively during emergency kidney transplantation with deceased donor due to vascular access failure from February 2013 to December 2014. Antithrombotic prophylaxis was not performed. We evaluated the postoperative complications, length of stay, early graft echo-Doppler, and renal function during the first year postoperatively. RESULTS Delayed graft function occurred in three cases. Two patients developed postoperative infection requiring antibiotics. One patient required reoperation due to post-renal biopsy complications. The mean length of stay was 31.2 days and the mean serum creatinine levels at discharge, at 6 months, and at 12 months postoperatively were 1.42 mg/dL, 0.86 mg/dL, and 0.82 mg/dL, respectively. All patients had normal ultrasonography. There were no losses of graft or deaths during follow-up. CONCLUSION Venous anastomosis using the gonadal vein in kidney transplantation for patients with iliac vein thrombosis and/or stenosis showed good clinical and surgical results, showing this method to be a viable alternative to venous drainage in these complex patients.
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Affiliation(s)
- J B G de Cerqueira
- Department of Surgery, Division of Urology, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil.
| | - C M C de Oliveira
- Division of Nephrology, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, CE, Brasil
| | - B G B Silva
- Undergraduate Medical Students of School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil
| | - L C O Santos
- Undergraduate Medical Students of School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil
| | - A G Fernandes
- Department of Surgery, Division of Urology, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil
| | - P F C B C Fernandes
- Division of Nephrology, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, CE, Brasil
| | - E L Maia
- Department of Surgery, Division of Urology, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brasil
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3
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Emergency Kidney Transplantation in Recipients With Iliocaval Thrombosis Using Splenic Vessel Anastomosis After Splenectomy: A Case Series. Transplant Proc 2018; 50:99-103. [PMID: 29407339 DOI: 10.1016/j.transproceed.2017.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/17/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022]
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4
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Lonze BE, Dagher NN, Alachkar N, Jackson AM, Montgomery RA. Nontraditional sites for vascular anastomoses to enable kidney transplantation in patients with major systemic venous thromboses. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Bonnie E. Lonze
- Transplant Institute; Department of Surgery; NYU Langone Medical Center; New York NY USA
| | - Nabil N. Dagher
- Transplant Institute; Department of Surgery; NYU Langone Medical Center; New York NY USA
| | - Nada Alachkar
- Division of Nephrology; Department of Medicine; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Annette M. Jackson
- Immunogenetics Laboratory; Department of Medicine; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Robert A. Montgomery
- Transplant Institute; Department of Surgery; NYU Langone Medical Center; New York NY USA
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5
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Insights in Transplanting Complex Pediatric Renal Recipients With Vascular Anomalies. Transplantation 2017; 101:2562-2570. [DOI: 10.1097/tp.0000000000001640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava. Transplant Direct 2016; 2:e82. [PMID: 27500272 PMCID: PMC4946523 DOI: 10.1097/txd.0000000000000592] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022] Open
Abstract
Background Children with a compromised inferior vena cava (IVC) were previously considered unsuitable for kidney transplantation because of the technical difficulties and the increased risk of graft thrombosis secondary to inadequate renal venous outflow. Methods We conducted a retrospective study of 11 transplants in 9 patients with end-stage renal disease and thrombosed IVCs who received adult kidney allografts between 2000 and 2015. The mean age at transplantation was 7.5 ± 3.5 years. A pretransplant diagnosis of the IVC thrombosis was made in 7 patients by magnetic resonance imaging and computerized tomography, whereas there were 2 instances of intraoperative discovery of the IVC thrombosis. Results In the early cases, a kidney was placed intraperitoneally at the right iliac fossa with a venous anastomosis to the patent segment of the suprarenal IVC. After 2008, however, 6 adult-sized kidneys were subsequently placed in the left orthotopic position. Venous drainage was attained to the infrahepatic IVC (n = 3), left native renal vein (n = 2), and ascending lumbar vein (n = 1). Moreover, a venous bypass was created between the graft and the splenic vein in 2 children who showed high return pressure after the vessel was declamped. The mean glomerular filtration rate of the functioning 8 grafts 1 year posttransplant was 73.4 ± 20.4 mL/min per 1.73 m2. Of note, 6 of the grafts have been functioning well, with a mean follow-up of 66 months. Both 1- and 5-year graft survival were 81.8%. Conclusions Transplantation into the left orthotopic position and the revascularization methods are an effective set of surgical techniques that could potentially be adopted as safe and reliable transplant approaches in children with IVC thrombosis.
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7
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Abstract
Vena cava thrombosis can represent a surgical challenge in the context of kidney transplantation. Selection of venous drainage in this setting should provide adequate venous outflow and minimize the risk of thrombosis and subsequent graft failure. We report the case of an adult female patient who presented for a deceased donor kidney transplant with incidental finding of complete inferior vena cava (IVC) and obliteration. After exploration of the retroperitoneal space up to the level of the obliterated IVC, a collateral venous branch was identified at the confluence of the right and left iliac veins. This was utilized as the site of the renal vein venous anastomosis. The patient recovered with immediate graft function. Follow-up ultrasound demonstrated patent vasculature without evidence of thrombosis or outflow obstruction. This report offers a surgical alternative to proceed in the case of an adult with unsuspected caval system obliteration.
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Cauley RP, Potanos K, Fullington N, Lillehei C, Vakili K, Kim HB. Reno-portal anastomosis as an approach to pediatric kidney transplantation in the setting of inferior vena cava thrombosis. Pediatr Transplant 2013; 17:E88-92. [PMID: 23461835 DOI: 10.1111/petr.12059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
Abstract
In pediatric renal transplantation in the setting of IVC thrombosis, the retrohepatic IVC or gonadal veins are often used for outflow. However, if use of systemic venous outflow is unsuccessful, options become limited. We report the use of the portal vein for venous outflow in kidney retransplantation in the setting of IVC thrombosis. The patient is a 19-month-old male who developed end-stage renal failure at seven months of age secondary to hypotension after spontaneous rupture of an accessory renal vein. The IVC was occluded during emergent laparotomy, and the patient developed extensive IVC thrombosis. The first two transplant attempts used the retrohepatic IVC for venous outflow. Despite good initial flow, in both instances the renal vein thrombosed on post-operative day 1. In an unsuccessful salvage attempt of the second transplant, a reno-portal anastomosis was performed. With few options for vascular access, a third transplant was attempted. The reno-portal stump from the second transplant was used for outflow. The patient recovered well from his third transplant (creatinine 0.6 mg/dL 35 months post-surgery), demonstrating that the portal vein can be used for outflow in cases of extensive IVC thrombosis.
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Affiliation(s)
- R P Cauley
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA
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9
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Successful splenic venous drainage for kidney transplant in case of inferior vena cava thrombosis. Transplantation 2011; 92:e59-60. [PMID: 22067218 DOI: 10.1097/tp.0b013e3182352d86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Wong VKH, Baker R, Patel J, Menon K, Ahmad N. Renal transplantation to the ovarian vein: a case report. Am J Transplant 2008; 8:1064-6. [PMID: 18312606 DOI: 10.1111/j.1600-6143.2008.02185.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Renal failure patients with absent or thrombosed inferior vena cava (IVC) and iliac veins are considered technically unsuitable for transplantation. Occasional cases have been reported in literature of transplant using inferior and superior mesenteric veins. We describe a case in which kidney was transplanted on to an ovarian vein in a young patient who had thrombosed IVC and iliac veins and was previously declared unsuitable for transplantation.
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Affiliation(s)
- V K H Wong
- Department of Transplantation, St. James's University Hospital, Leeds, LS9 7TF, UK
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11
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Arash Mohammadi Tofigh, Coscas R, Koskas F, Kieffer E. Surgical Management of Deep Venous Insufficiency Caused by Congenital Absence of the Infrarenal Inferior Vena Cava. Vasc Endovascular Surg 2008; 42:58-61. [DOI: 10.1177/1538574407306791] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital absence of the inferior vena cava (CAIVC) is a rare vascular defect, commonly reported as a fortuitous finding because patients are typically asymptomatic of the condition itself but are symptomatic of associated conditions such as congenital heart disease, polysplenia, asplenia, and inversion of bowel viscera. The presence of CAIVC is probably underestimated because CAIVC may not be detected by compression B-mode ultrasonography. By use of computed tomography, we diagnosed a case of CAIVC in a young athletic patient with disabling venous stasis symptoms of the lower limbs. Venous prosthetic reconstruction of the infrarenal vena cava provided with early subsiding of edema and healing of stasis ulcers. An intracaval web was found as potentially responsible for the condition. We present and propose our surgical method for this rare disabling condition.
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Affiliation(s)
| | - Raphaël Coscas
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
| | - Edouard Kieffer
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
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12
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Martinez-Urrutia MJ, Pereira PL, Ramirez LA, Romera RL, Melgar AA, Monereo EJ, Larrucea JT. Renal transplant in children with previous inferior vena cava thrombosis. Pediatr Transplant 2007; 11:419-21. [PMID: 17493223 DOI: 10.1111/j.1399-3046.2007.00680.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Our experience with renal transplantation in children with inferior vena cava thrombosis is presented in this study. Of the 238 children who have received renal transplants at our institution, four had IVC thrombosis (discovered during pretransplant evaluation: three patients; found at surgery: one patient). The pretransplant US evaluation diagnosis of IVC thrombosis in three patients was confirmed by transjugular retrograde cavography. There were no signs of hypercoagulability or IVC thrombosis symptoms prior to diagnosis in any patient. The graft was implanted in a left orthotopic position in three patients. Venous drainage was attained to the infrahepatic vena cava or native renal vein after ipsilateral nephrectomy. The renal artery of the graft was anastomosed to the aorta. In one patient, the graft was placed in the left iliac fossa. Patient and graft survival are 100%. Three grafts are functioning normally after a mean follow-up of 3.7 yr. The graft placed in the iliac fossa has moderate dysfunction due to high pressure venous outflow. Children with IVC thrombosis can be successfully transplanted orthotopically. Candidates with any suspicious-looking occlusion on ultrasound should be studied by retrograde venography to confirm diagnosis prior to transplantation.
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13
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Abstract
For renal transplantation, the standard venous drainage of the allograft is via the iliac vein. In unusual circumstances, such as thrombosis or agenesis of the iliac veins and the inferior vena cava, portal venous drainage may be a suitable option. We report a case in which the inferior mesenteric vein was used for venous drainage of a cadaveric renal allograft.
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Affiliation(s)
- Pratik Patel
- Section of Renal Transplantation, The Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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14
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Abstract
Despite the many possible modes of presentation, congenital anomalies of the inferior vena cava are increasingly being found in asymptomatic patients. Although plain chest radiography may reveal enough suggestive signs, the diagnosis is usually confirmed by ultrasound, computed tomography and magnetic resonance imaging. The authors present a case of infrarenal absence of the inferior vena cava that presented as a retroperitoneal mass and discuss the embryology and clinical implications of this unusual entity.
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Affiliation(s)
- Gavin D Sandercoe
- Department of Surgery, Auburn Hospital, Auburn, New South Wales, Australia
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15
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Aguirrezabalaga J, Novas S, Veiga F, Chantada V, Rey I, Gonzalez M, Gomez M. Renal transplantation with venous drainage through the superior mesenteric vein in cases of thrombosis of the inferior vena cava. Transplantation 2002; 74:413-5. [PMID: 12177625 DOI: 10.1097/00007890-200208150-00022] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Renal transplantation usually is performed by placing the graft in the iliac fossa, anastomosing the renal vein to the iliac vein or, when this is not possible, to the vena cava. When vascular complications occur, particularly on the venous side, the position of the graft may have to be changed. This report describes orthotopic renal grafts and positioning of the organ with anastomosis to the splenic vessels. Venous drainage was established directly into the mesenteric-portal territory, with two cases to the portal vein and one to the inferior mesenteric vein. A new technique for the venous drainage of the renal graft is shown. We have used this model in two cases of infrarenal inferior vena cava thrombosis. The kidney was located in a retroperitoneal position, with venous drainage to the superior mesenteric vein through an orifice in the posterior peritoneum.
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16
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Arrazola L, Long A, Moss A, Sozen H, Najarian J. An absent inferior vena cava in a pediatric renal transplant recipient. Clin Transplant 2000; 14:360-2. [PMID: 10945209 DOI: 10.1034/j.1399-0012.2000.140414.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- L Arrazola
- Department of Surgery, University of Minnesota, Minneapolis 55455, USA
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17
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18
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Ozan H. An unusual course of the right renal artery associated with an anomalous inferior vena cava. Ann Anat 1998; 180:569-72. [PMID: 9862039 DOI: 10.1016/s0940-9602(98)80069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In a 55-year-old male cadaver, the inferior vena cava bifurcated at a level midway between the hilus and inferior pole of the right kidney. The narrower branch, on the right side, drained the right renal and hepatic veins, ascended as the normal inferior vena cava, passed through the caval opening of the diaphragm and drained into the right atrium. The wider branch on the left side drained the left renal vein and penetrated the right crus of the diaphragm as the azygos vein. This vein ascended in the posterior mediastinum and drained into the superior vena cava. The hemiazygos and accessory hemiazygos veins were absent. In addition to these anomalies, the right renal artery entered the hilus after coursing through the above-mentioned two branches at the bifurcation. No congenital anomalies of the heart or abdominal viscera and main arteries were seen.
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Affiliation(s)
- H Ozan
- Gülhane Military Medical Academy, Faculty of Medicine, Department of Anatomy, Ankara, Turkey
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19
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Bar-Nathan N, Shmueli D, Yussim A, Lustig S, Eisenstein B, Davidovitch M, Shaharabani E, Sobolev V, Shapira Z. Alternative venous drainage for renal transplantation. Transplant Proc 1997; 29:2660-1. [PMID: 9290781 DOI: 10.1016/s0041-1345(97)00547-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- N Bar-Nathan
- Department of Organ Transplantation, Rabin Medical Center, Petach Tikva, Israel
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20
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Abstract
Twenty-one infants, 2 years old or younger, received 21 renal transplants between 1983 and 1995. Six of the transplantations were performed from 1983 to 1989, and the remaining 15 were performed from 1990 to 1995. The median age at transplantation was 16.0 months and the median body weight was 9.0 kg. Living-related donor kidneys were used in 15 cases, an adult cadaveric donor kidney was used in one case, and pediatric cadaveric donor kidneys were used in five cases. All grafts were placed intra-abdominally. The immunosuppressive therapy consisted of cyclosporine, azathioprine, and prednisolone. No prophylactic antithymocyte globulins were used. Five infants have died, one with a functioning graft and four after loss of graft function. All graft losses and deaths occurred during the first 6 months after transplantation. The 5-year patient survival and graft survival rates were 87% for recipients of living donor grafts and 44% for recipients of cadaveric grafts. The median height SD score increased from -3.7 before operation to -1.9 at 1 year, -0.7 at 3 years, and -1.1 at 5 years. The glomerular filtration rate in absolute values remained stable in all infants, whereas a reduction in glomerular filtration rate related to body surface area was seen at follow-up, 5 years after transplantation. We conclude that renal transplantation can be performed with good long-term results in children less than 2 years old.
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Affiliation(s)
- G Tydén
- Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Sweden
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21
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Shah NL, Shanley CJ, Prince MR, Wakefield TW. Deep venous thrombosis complicating a congenital absence of the inferior vena cava. Surgery 1996; 120:891-6. [PMID: 8909527 DOI: 10.1016/s0039-6060(96)80100-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- N L Shah
- Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0329, USA
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