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Viet KN, Hoang T, Hai DD, Dinh DT, Bao NN, Nguyen VL, Duc HD. Efficacy of lengthening right renal veins using accompanying gonadal veins in living donor kidney transplantation. World J Urol 2024; 42:407. [PMID: 38990349 DOI: 10.1007/s00345-024-05094-y] [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: 12/12/2023] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Short harvested right renal veins (RV) are quite common in living donor kidney transplantation (KT). This technical difficulty might interfere implanting and increase warm ischemic time. Several techniques to overcome this problem have been applied, including iliac vein transposition, inverted transplant, synthetic graft, saphenous vein… Application of accompanying gonadal vein (GV), which is easily approachable and less time-consuming, has been recently published. This study aims to evaluate its effectiveness and safety. METHODS Retrospective study on KT using the gonadal vein to lengthen the short right renal vein at Viet Duc University Hospital from April 2019 to April 2022. The following data were gathered: baseline characteristics, vascular imaging in CT scan/after nephrectomy and after reconstruction (mm), reconstruction and surgical time, hospitalization days. The outcomes were determined by kidney function after transplantation (plasma creatinine, creatinine clearance) and related complications. RESULTS Twenty-five cases with procured right kidney with short RV from the living donor which were reconstructed and lengthened by the accompanying GV were collected. The additional length of RV was 15.9 ± 2.4 mm. Average cold ischemic time, venoplasty time, warm ischemic time were 60.4 ± 8.2, 21.2 ± 5.3, and 38.1 ± 5.6 min, respectively. The average hospital stay was 15.3 ± 3.2 days. Average follow-up time was 31 ± 5.2 months, creatinine clearance was around 60 ml/min after 1 year, no vascular or urologic complications was observed. CONCLUSION Accompanying GV from a living donor to lengthen short right RV in KT is a feasible, safe, and effective technique.
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Affiliation(s)
- Khai Ninh Viet
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Tuan Hoang
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Dang Do Hai
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam.
| | - Dung Tran Dinh
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Ngoc Ninh Bao
- HNUE High school for gifted students, Hanoi, Vietnam
| | - Vu Le Nguyen
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Hung Duong Duc
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, Vietnam
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2
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Emmanouilidis N, Hashem AAB, Stiegler P, Ringe BP, Alten TA, Klempnauer J, Schrem H. Transplanting a left or right donor kidney into the left or right iliac fossa: importance of laterality and site of venous anastomosis. Updates Surg 2023:10.1007/s13304-023-01512-9. [PMID: 37171776 DOI: 10.1007/s13304-023-01512-9] [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: 11/04/2022] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
Data on the impact of donor-to-recipient laterality on kidney transplantation are lacking. This study evaluated the impact of donor-to-iliac fossa laterality and the site of venous anastomosis on operating time and surgical outcome. This retrospective single-center study analyzed 1262 deceased donor adult kidney transplants into pristine iliac fossa. Multivariable linear and logistic regression analyses were used to identify variables with an impact on operating time and surgical complications. Operating time was shorter by 11 min in median for transplantations into the right iliac fossa compared to the left iliac fossa (p < 0.001). Operating time in left-to-right donor-to-recipient combination was shorter by 17 min in median if venous anastomoses were performed on the caval vein or common iliac vein as compared to anastomoses to the external iliac vein (p < 0.001). Overall, the shortest operating times (median 112.5 min) were achieved in left-to-right donor-to-recipient combinations with venous anastomosis to the caval or common iliac vein, without an increase in surgical complications. Kidney transplantation into the right iliac fossa with anastomosis to the caval vein or the common iliac vein saves operating time and reduces thrombotic complications. Acceptance of a left donor kidney is likely to further reduce operating time.
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Affiliation(s)
- Nikos Emmanouilidis
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
- General, Visceral, Thoracic and Minimalinvasive Surgery, St. Elisabeth Hospital, Stadtring Kattenstroth 130, 33332, Gütersloh, Germany.
| | | | - Philipp Stiegler
- Department of Transplant Surgery, Medizinische Universität Graz, Graz, Austria
| | - Bastian Paul Ringe
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Alexander Alten
- Department of Radiology, Hannover Medical School, Hannover, Germany
- Department of Radiology, St. Vincenz Hospital Paderborn, Paderborn, Germany
| | - Jürgen Klempnauer
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
- Department of Transplant Surgery, Medizinische Universität Graz, Graz, Austria
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Hannover Medical School, Hannover, Germany
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Wakita T, Tsutahara K, Miki A, Horibe Y, Tani M, Kakuta Y, Takao T. Upside-Down Kidney Transplantation in a Recipient with Severe Arteriosclerosis: A Case Report. Transplant Proc 2023:S0041-1345(23)00146-X. [PMID: 37085383 DOI: 10.1016/j.transproceed.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 04/23/2023]
Abstract
Recently, the number of patients with significant arteriosclerosis has been increasing owing to the aging of kidney transplant patients, an increase in the number of patients with kidney failure with diabetes as the primary disease, and an increase in the number of patients undergoing long-term dialysis. Severe atherosclerosis in kidney transplant recipients makes it difficult to determine the site of vascular anastomosis and increases the technical difficulty of the surgical procedure. This study presents a case of upside-down kidney transplantation in a recipient with severe arteriosclerosis. The patient was a 58-year-old male with diabetic nephropathy. He received an ABO-compatible living donor kidney transplant from his wife. Preoperative computed tomography revealed a mild calcification of the external iliac artery. However, during surgery, more than half of the external iliac artery was found to be calcified, making vascular anastomosis difficult. The peripheral side of the external iliac artery showed mild atherosclerosis. Therefore, the vessel could be anastomosed to the peripheral side of the external iliac artery by turning the kidney graft upside-down for use as the anastomosis site. The postoperative course was uneventful, and the kidney function was good at the last follow-up. Upside-down kidney transplantation is safe in patients with severe arteriosclerosis.
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Affiliation(s)
- Teppei Wakita
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Koichi Tsutahara
- Department of Urology, Osaka General Medical Center, Osaka, Japan.
| | - Airi Miki
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Yuki Horibe
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Masaru Tani
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Yoichi Kakuta
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Tetsuya Takao
- Department of Urology, Osaka General Medical Center, Osaka, Japan
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4
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Kim JK, Yadav P, Chua ME, Rickard M, Lorenzo AJ. Assessing the role of upside-down (inverted) renal allografts in pediatric kidney transplantation: a propensity-score matched analysis. Int Urol Nephrol 2023; 55:861-866. [PMID: 36723828 DOI: 10.1007/s11255-023-03485-5] [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: 12/29/2022] [Accepted: 01/21/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the implications of inverted (upside-down) kidney configuration in pediatric renal transplantation employing a comparative analysis with at least 1-year follow-up. METHODS Patients who underwent kidney transplantation at our institution between January 2011 and June 2021 were reviewed. Patients who had an inverted renal transplant were propensity-score matched (PSM) in 1:2 ratio with those who had traditional orientation transplant. The outcomes assessed included delayed graft function (DGF), urine leak, lymphocele, rejection, allograft calculus, ureteric stricture, and nadir creatinine. RESULTS A total of 24 patients with inverted orientation were identified. Following PSM, 41 patients were matched, with exclusions due to incompatible propensity scores. Baseline characteristics were appropriately matched, and no significant differences were noted between the two groups. There were no differences in: delayed graft function (0/24 vs. 3/41, p = 0.290), urine leak (3/24 vs. 2/41, p = 0.350), lymphocele (2/24 vs. 4/41, p = 1.000), rejection (3/24 vs. 5/41, p = 1.000), graft calculus (2/24 vs. 0/41, p = 0.133), and ureteric stricture (0/24 vs. 2/41, p = 0.527). The two cases of renal calculus seen in the inverted transplant group occurred on post-operative day 13 and 1584, both were managed without complications. There was no difference in nadir creatinine (median 34umol/L IQR23-57 vs. 35 umol/L IQR 20-50, p = 0.624) or time to nadir creatinine (8 days IQR 6-12 vs. 8 days IQR 7-28, p = 0.315). CONCLUSION Inverting a renal allograft does not appear to significantly contribute to increased risk of post-operative adverse outcomes. When aiming to achieve the best anatomical placement to secure a comfortable vascular anastomosis, inverting the allograft should be considered.
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Affiliation(s)
- Jin K Kim
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University AveToronto, Toronto, ON, M5G 1X8, Canada.
| | - Priyank Yadav
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University AveToronto, Toronto, ON, M5G 1X8, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University AveToronto, Toronto, ON, M5G 1X8, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University AveToronto, Toronto, ON, M5G 1X8, Canada
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Bueno Jimenez A, Larreina L, Serradilla J, de Borja Nava F, Lobato R, Rivas S, Lopez-Pereira P, García L, Espinosa L, Martinez-Urrutia MJ. Upside-down kidney placement: An alternative in pediatric renal transplantation. J Pediatr Surg 2021; 56:1417-1420. [PMID: 33139030 DOI: 10.1016/j.jpedsurg.2020.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE "Upside-down" kidney placement has been reported as an acceptable alternative in cases of technical difficulty in kidney transplantation but there are few reports in the pediatric population. The aim of our study is to analyze whether the placement of the upside-down kidney could affect graft outcome or produce more complications. MATERIALS AND METHODS A retrospective study was conducted of pediatric kidney transplants performed in our center between 2005 and 2017 with at least 6 months' follow-up. Epidemiological and anthropometric data, type of donor (deceased/living), graft position (normal/upside-down), reason for the upside-down placement, early, medium and long-term complications and renal function were analyzed and compared with patients transplanted in the same period with a normal graft placement. RESULTS From 181 transplants, 167 grafts were placed in a normal position (mean age: 10 y and mean weight: 30 kg) and 14 were placed upside-down (10 y, 37 kg) mainly because of vessel shortness after laparoscopic nephrectomy. Male predominance was observed in both groups. 57% of grafts from the control group and 64% of those from study group came from a living donor. Four vascular and two ureteral re-anastomoses were recorded in the control group and two vascular and one ureteral re-anastomosis in the study group (p > 0.05). In the latter group, no grafts have been lost due to vascular or urological causes and no patients have required dialysis. CONCLUSIONS When necessary, an upside-down placement for the renal graft is a safe alternative in the pediatric population. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Leire Larreina
- La Paz Children's Hospital, Pediatric Urology, Madrid, Spain
| | | | | | - Roberto Lobato
- La Paz Children's Hospital, Pediatric Urology, Madrid, Spain
| | - Susana Rivas
- La Paz Children's Hospital, Pediatric Urology, Madrid, Spain
| | | | - Leire García
- La Paz Children's Hospital, Pediatric Nephrology, Madrid, Spain
| | - Laura Espinosa
- La Paz Children's Hospital, Pediatric Nephrology, Madrid, Spain
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Ciancio G, Farag A, Gaynor JJ, Morsi M, Chen L, Burke GW. Midline Rotation of the Right Renal Hilum During Hand-Assisted Laparoscopic Living Donor Nephrectomy. JSLS 2021; 25:e2021.00018. [PMID: 34248334 PMCID: PMC8241287 DOI: 10.4293/jsls.2021.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/OBJECTIVES Laparoscopic living donor nephrectomy (LLDN) of the right kidney is currently considered as part of standard of care; however, dealing with the renal hilum when performing ligation/division of its renal vessels is still a main concern. Here, we describe a simple-to-perform technique, i.e., flipping the fully mobilized right kidney to the midline so that the renal artery becomes anteriorly, which offers better visualization and easier dissection of the renal vessels (achieving maximized lengths) when performing hand-assisted LLDN of the right kidney. METHODS Living donors who underwent hand-assisted LLDN of the right kidney, along with their respective renal transplant recipients, were included in this report. Donor characteristics included renal artery and vein lengths; recipient characteristics included creatinine at months 12 - 36. Graft vein and arterial anastomosis data were also reported. RESULTS Nineteen living donors and 19 recipients, with median donor and recipient ages being 39 (24 - 60) and 53 (3 - 81) years, respectively, were included. None of the 38 patients had intra- or postoperative complications. Donor renal vein was anastomosed to the right external iliac vein (n = 16), right common iliac vein (n = 2), and inferior vena cava (n = 1). Gonadal vein (n = 1) and deceased donor iliac vein (n = 2) were used to increase the right renal vein length in 3 cases. Four donor kidneys had 2 arteries reconstructed side by side. None of the recipients developed any vascular or urological complications. CONCLUSIONS The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.
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Affiliation(s)
- Gaetano Ciancio
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Ahmed Farag
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Jeffrey J Gaynor
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Mahmoud Morsi
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Linda Chen
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - George W Burke
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
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7
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Kinoshita Y, Iwami D, Fujimura T, Kume H, Yokoo T, Kobayashi E. Techniques of orthotopic renal transplantation in pigs. One donor to two recipients via inverted grafting. Acta Cir Bras 2021; 36:e360208. [PMID: 33624724 PMCID: PMC7902078 DOI: 10.1590/acb360208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/24/2020] [Accepted: 01/23/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Although transplanting two kidneys from a single donor to two recipients has some advantages, the right and left kidneys are not anatomically identical; thus, a surgical procedure considering the anatomical features of the donor kidneys is needed when transplanting them into the opposite renal fossae. Based on vast experience, the surgical details of pig orthotopic kidney transplantation from one donor to two recipients was reported. METHODS When the right kidney was transplanted to the left renal fossa, the graft was inverted upside down, not backwards, thus ensuring that the anteroposterior relationship of the renal vessels was maintained and anatomically natural vascular anastomosis could be performed. RESULTS Using this technique, we could have developed a pig experimental model that is safe and has a high success rate, even for researchers in the middle of their training. This technique of inverting the graft upside down was reported in human kidney transplantation to make vascular anastomosis easier. CONCLUSIONS In pig orthotopic kidney transplantation from one donor to two recipients, an anatomically natural vascular anastomosis could be performed via inverted grafting when the right kidney was transplanted into the left renal fossa.
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Affiliation(s)
- Yoshitaka Kinoshita
- MD. Jichi Medical University – Department of Urology – Division of
Renal Surgery and Transplantation – Tochigi, Japan. Jichi Medical University –
Department of Urology – Division of Urology – Tochigi, Japan
| | - Daiki Iwami
- MD, PhD. Jichi Medical University – Department of Urology – Division
of Renal Surgery and Transplantation – Tochigi, Japan
| | - Tetsuya Fujimura
- .MD, PhD. Jichi Medical University – Department of Urology –
Division of Urology – Tochigi, Japan
| | - Haruki Kume
- MD, PhD. The University of Tokyo – Graduate School of Medicine –
Department of Urology – Tokyo, Japan
| | - Takashi Yokoo
- MD, PhD. The Jikei University School of Medicine – Department of
Internal Medicine – Division of Nephrology and Hypertension – Tokyo, Japan
| | - Eiji Kobayashi
- MD, PhD. The Jikei University School of Medicine – Department of
Kidney Regenerative Medicine; Keio University School of Medicine – Department of
Organ Fabrication – Tokyo, Japan
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8
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Ramesh S, Taylor K, Koyle MA, Lorenzo AJ. "Inverted" positioning of renal allograft during kidney transplantation in children and adolescents: A single-institution comparative analysis. Pediatr Transplant 2019; 23:e13365. [PMID: 30734454 DOI: 10.1111/petr.13365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/18/2018] [Accepted: 11/29/2018] [Indexed: 11/27/2022]
Abstract
Renal transplantation is the treatment of choice in children with end-stage renal failure. Limitations in patient anatomy or a short donor renal vein may necessitate intraoperative inversion of the kidney. There is little evidence to support the use of this surgical technique, and no evidence in the pediatric population. This study identifies the perioperative and post-operative outcomes of inverted renal transplants in pediatric patients. We reviewed all patients having a renal transplant between January 2012 and December 2016 and collected short- and long-term outcomes of patients who received an inverted allograft. Early graft function was defined as the time to reach creatinine nadir. During this time, our hospital performed 81 transplants, and 50 (62%) were from deceased donors, including the 6 (12%) patients who received inverted renal grafts. Half (3/6) were female, 5/6 (83%) were dialysis-dependent, and the median age at surgery was 13 years (range 9-16 years). There was no significant difference in mean creatinine nadir values (P = 0.518) and the time to creatinine nadir mean values (P = 0.190) between the upright and inverted renal transplant groups. There were also no significant differences in rates of post-operative complications between the upright and inverted allograft recipients. Inversion of renal allografts in pediatric patients is a viable surgical technique to compensate for shortcomings in patient anatomy or in special cases of renal transplantation involving a short donor renal vein. Future research should focus on outcomes of a larger group of pediatric inverted renal transplant patients.
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Affiliation(s)
- Smruthi Ramesh
- Department of Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katherine Taylor
- Department of Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Martin A Koyle
- Department of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Department of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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9
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Gyawali P, Poudyal S, Chapagain S, Luitel B, Chalise P, Sharma U. Upside-down kidney transplantation using single-suture single-knot technique. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_18_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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10
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Laparoscopic Live Donor Nephrectomy: Comparison of Outcomes Right Versus Left. Transplant Proc 2018; 50:2327-2332. [DOI: 10.1016/j.transproceed.2018.03.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 02/23/2018] [Accepted: 03/06/2018] [Indexed: 01/03/2023]
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EXP CLIN TRANSPLANTExp Clin Transplant 2016; 14. [DOI: 10.6002/ect.2015.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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McAlpine K, Leveridge MJ, Beiko D. Outpatient percutaneous nephrolithotomy in a renal transplant patient: World's first case. Can Urol Assoc J 2015; 9:E324-8. [PMID: 26029308 DOI: 10.5489/cuaj.2414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for renal calculi in renal allografts. The advent of tubeless PCNL has led to reports of ambulatory or outpatient PCNL. This case report describes the successful outpatient management of a 49-year-old female with a symptomatic renal pelvic calculus in her transplanted kidney. Tubeless PCNL successfully removed the stone, free of complication, and the patient was discharged 2 hours and 17 minutes after the procedure in stable condition with minimal pain. This is, to the best of our knowledge, the first successful case of outpatient tubeless PCNL in a transplanted kidney.
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Affiliation(s)
- Kristen McAlpine
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
| | - Michael J Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
| | - Darren Beiko
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
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14
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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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15
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Pandarinath SR, Choudhary B, Chouhan HS, Rudramani S, Dubey D. Transperitoneal laparoscopic left versus right live donor nephrectomy: Comparison of outcomes. Indian J Urol 2014; 30:256-60. [PMID: 25097308 PMCID: PMC4120209 DOI: 10.4103/0970-1591.134244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Although laparoscopic donor nephrectomy (LDN) is being performed at many centers, there are reservations on the routine use of laparoscopy for harvesting the right kidney due to a perception of technical complexity and increased incidence of allograft failure, renal vein thrombosis and the need for more back-table reconstruction along with increased operative time. Materials and Methods: We performed a prospective non-randomized comparison of transperitoneal laparoscopic left donor nephrectomy (LLDN) with laparoscopic right donor nephrectomy (RLDN) from August 2008 to May 2013. The operative time, warm ischemia time, intraoperative events, blood loss and post-operative parameters were recorded. The renal recipient parameters, including post-operative creatinine, episodes of acute tubular necrosis (ATN) and delayed graft function were also recorded. Results: A total of 188 LDN were performed between August 2008 and May 2013, including 164 LLDN and 24 RLDN. The demographic characteristics between the two groups were comparable. The operative duration was in favor of the right donor group, while warm ischemia time, estimated blood loss and mean length of hospital stay were similar between the two groups. Overall renal functional outcomes were comparable between the two donor groups, while the recipient outcomes including creatinine at discharge were also comparable. Conclusions: RLDN has a safety profile comparable with LLDN, even in those with complex vascular anatomy, and can be successfully performed by the transperitoneal route with no added morbidity. RLDN requires lesser operative time with comparable morbidity.
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Affiliation(s)
| | - Babulal Choudhary
- Department of Urology, Manipal Hospital, Old Airport Road, Bangalore, Karnataka, India
| | | | | | - Deepak Dubey
- Department of Urology, Manipal Hospital, Old Airport Road, Bangalore, Karnataka, India
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16
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Simforoosh N, Soltani MH, Basiri A, Tabibi A, Gooran S, Sharifi SHH, Shakibi MH. Evolution of laparoscopic live donor nephrectomy: a single-center experience with 1510 cases over 14 years. J Endourol 2013; 28:34-9. [PMID: 24074354 DOI: 10.1089/end.2013.0460] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study evaluated the outcomes of laparoscopic donor nephrectomy (LDN) and proposed modifications for kidney donation surgery. From February 1997 to February 2011, 1510 LDNs were performed. PATIENTS AND METHODS Surgical modifications included a modified open access technique for entry into the abdominal cavity, using vascular clips for safe and cost-effective control of the renal pedicle, control of the lumbar veins, and adrenal vein using bipolar cautery instead of clips, and leaving the gonadal vein intact with the ureter. Kidneys were extracted by hand through a Pfannenstiel incision. Heparin was not used after the first 300 cases to prevent potential hemorrhagic complications. RESULTS Although three major vascular injuries occurred using the closed access method that were managed successfully, no access-related complications occurred using the modified open access technique. Clip failure did not happen in any cases. Patient and graft survival at 1 year post-transplantation were 96.5% and 95.5%, respectively, and at 5 years post-transplantation were 95.3% and 89.5%, respectively. CONCLUSION The proposed surgical modifications are based on 14 years of experience and 1510 cases, and make LDN simple, safe, and cost-effective. The excellent recipient and graft outcomes with minimal morbidity obtained further confirm that LDN can be considered as the gold standard for kidney donation surgery.
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Affiliation(s)
- Nasser Simforoosh
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Islamic Republic of Iran
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Puche-Sanz I, Pascual-Geler M, Vázquez-Alonso F, Hernández-Vidaña AM, Flores-Martín JF, Espejo-Maldonado E, Cózar-Olmo JM. Right renal vein extension with cryopreserved external iliac artery allografts in living-donor kidney transplantations. Urology 2013; 82:1440-3. [PMID: 24094655 DOI: 10.1016/j.urology.2013.07.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 07/02/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A short right renal vein remains a challenge for renal transplant surgery, especially in the living donor. Our objective was to report on a new technique to solve this problem. TECHNICAL CONSIDERATIONS We describe our experience with the use of cryopreserved iliac artery grafts for right renal vein extension. Two renal grafts from living donors with a short right renal vein were subjected to an extension with a cryopreserved external iliac artery allograft. There were no perioperative or postoperative complications. There were also no changes in ischemia times. The renal implantation was performed easily and conveniently using our standard technique. For the first and second procedures, at 3 and 3.5 years after surgery, respectively, both vascular grafts maintain good patency, and the renal function of both recipients is optimal. CONCLUSION Tissue-banked cryopreserved cadaveric vessels can be a useful tool in renal transplant surgery. The use of a cryopreserved iliac artery for renal vein extension is a simple and effective new technique that can be added to the pool of surgical solutions for a short renal vein in living-donor kidney transplantation. To our knowledge, this is the first time that the use of such grafts for this purpose has been described.
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Affiliation(s)
- Ignacio Puche-Sanz
- Department of Urology, Hospital Universitario Virgen de las Nieves, Granada, Spain.
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Simforoosh N, Sarhangnejad R, Basiri A, Ziaee SAM, Sharifiaghdas F, Tabibi A, Nouralizadeh A, Kashi AH, Moosanejad N. Vascular Clips Are Safe and a Great Cost-Effective Technique for Arterial and Venous Control in Laparoscopic Nephrectomy: Single-Center Experience with 1834 Laparoscopic Nephrectomies. J Endourol 2012; 26:1009-12. [DOI: 10.1089/end.2011.0619] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nasser Simforoosh
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
| | - Reza Sarhangnejad
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
| | - Abbas Basiri
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
| | - Seyed Amir Mohsen Ziaee
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
| | - Farzaneh Sharifiaghdas
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
| | - Ali Tabibi
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
| | - Akbar Nouralizadeh
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
| | - Amir H Kashi
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
| | - Nadali Moosanejad
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran
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Renal vein lengthening using gonadal vein reduces surgical difficulty in living-donor kidney transplantation. World J Surg 2012; 36:468-72. [PMID: 21882021 DOI: 10.1007/s00268-011-1243-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND During living-donor kidney transplantation, to maximally decrease donor injury, the right kidney with lower glomerular filtration rate often is selected as the donor kidney. However, the renal vein of the right kidney is relatively short for transplantation. The gonadal vein is essentially useless and is easily accessed during the donor nephrectomy. METHODS Seventeen live kidney donors received right kidney nephrectomy for living-donor kidney transplantation. Short renal veins were lengthened by circular anastomosis or spiral anastomosis of longitudinally cut gonadal veins. The renal function of receivers was evaluated using creatinine clearance. RESULTS The renal veins were extended by 2.0-2.7 cm with circular anastomosis and 4.1-4.5 cm with spiral anastomosis with an average of 2.5 ± 0.7 cm. Lengthening of renal veins averaged 20.4 ± 4.2 min. All surgeries were successful, significantly reducing difficulty of vascular anastomosis during transplantation. No poor early graft function occurred. No side effects were observed in donors. CONCLUSIONS When donor renal veins are too short for effective kidney transplantation and may affect reliability of vascular anastomosis, they can be lengthened by using gonadal veins without increasing injury to the donor. Successful extension of donor kidney renal veins expands the indication for right donor kidneys.
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Alcocer F, Zazueta E, Montes de Oca J. The Superficial Femoral Vein: A Valuable Conduit for a Short Renal Vein in Kidney Transplantation. Transplant Proc 2009; 41:1963-5. [DOI: 10.1016/j.transproceed.2009.02.098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 02/23/2009] [Indexed: 11/17/2022]
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Thomas AJ, Kekre NS. Right laparoscopic donor nephrectomy and the use of inverted kidney transplantation: an alternative technique. BJU Int 2008; 101:1052; author reply 1052-3. [PMID: 18353160 DOI: 10.1111/j.1464-410x.2008.07609_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sener A, Cooper M. Live donor nephrectomy for kidney transplantation. ACTA ACUST UNITED AC 2008; 5:203-10. [PMID: 18268550 DOI: 10.1038/ncpuro1047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 01/03/2008] [Indexed: 11/09/2022]
Abstract
The number of patients with end-stage renal disease is increasing substantially every year around the world. Renal transplantation is the best treatment option to improve survival and quality of life. Although the numbers of living, related and deceased transplant donors has also increased, this growth is insufficient to keep up with the expansion rate of the renal failure population. The introduction of laparoscopic donor nephrectomy has gained widespread acceptance by physicians and patients, and seems to be better than open donor nephrectomy in terms of reduced postoperative pain, quick recovery and improved cosmetic outcomes. Evidence strongly suggests that graft survival is similar in recipients of kidneys from living related and unrelated donors. Fortunately, this information has raised awareness of the suitability of potential live, unrelated donors, including spouses, friends, or even anonymous donors. In this Review we touch on sociological aspects of living related kidney transplantation and review the available and proposed methods of increasing the live donor pool, including organ exchange and desensitization protocols for ABO-incompatible and cross-match-positive donor pairs.
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Affiliation(s)
- Alp Sener
- Division of Transplantation, University of Maryland Medical Center, Baltimore, MD 21201, USA
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