1
|
Kimura R, Izumi K, Tanaka K, Oshiro Y, Saito S. Ex Vivo Partial Nephrectomy and Autotransplantation for Complex and Multifocal Renal Cell Carcinoma at a Single Institution: A Case Series. Cureus 2024; 16:e53686. [PMID: 38322096 PMCID: PMC10845002 DOI: 10.7759/cureus.53686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/08/2024] Open
Abstract
Renal autotransplantation is a rare surgical procedure designed to preserve renal function in patients with complex urinary system diseases or highly complex renal tumors. Between 2012 and 2023, four patients underwent ex vivo partial nephrectomy (PN) and autotransplantation for complex renal tumors at our hospital. Two patients had bilateral multifocal renal tumors, including von Hippel Lindau (VHL) disease and hybrid oncocytic chromophobe tumor (HOCT). The remaining two patients had highly complex renal tumors with Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score of 12, one of whom had a solitary kidney. None of the patients experienced any postoperative surgical complications. Pathologically, nine of the excised tumors had negative surgical margins, except for one of the four tumors on HOCT. Postoperative renal function decreased at one month compared to preoperative renal function (P = 0.01); however, there was no significant difference at three months (P = 0.07). None of the patients had a local recurrence or metastasis at the latest follow-up.Ex vivo PN and autotransplantation are feasible and reasonable treatment methods for highly complex and multifocal renal tumors regarding safety, local tumor control, and preservation of renal function.
Collapse
Affiliation(s)
- Ryu Kimura
- Department of Urology, University of the Ryukyus, Nishihara, JPN
| | - Keiichiro Izumi
- Department of Urology, University of the Ryukyus, Nishihara, JPN
| | - Kei Tanaka
- Department of Urology, University of the Ryukyus, Nishihara, JPN
| | | | - Seiichi Saito
- Department of Urology, University of the Ryukyus, Nishihara, JPN
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Artiles Medina A, Gómez Dos Santos V, Hevia Palacios V, Laso García I, Rivero Belenchón I, Gómez Ciriza G, Santiago González M, Mata Alcaraz M, Medina López R, Burgos Revilla FJ. Kidney Autotransplantation in the Management of Residual Retroperitoneal Mass in a Germ Cell Tumor. Transplant Proc 2022; 54:1583-1588. [PMID: 35907696 DOI: 10.1016/j.transproceed.2022.03.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 10/16/2022]
Abstract
The main indication for kidney autotransplantation is ureteric disease, although it is also performed to treat renovascular diseases or neoplasms, such as complex intrasinusal kidney tumors or in patients with a solitary kidney. Only a few cases of kidney autotransplantation in the context of resection of complex retroperitoneal masses have been reported in the literature. CASE PRESENTATION: We report the case of a 26-year-old man with history of nonseminomatous germ cell tumor who had undergone a left radical orchiectomy 3 months earlier. Follow-up computed tomography revealed a residual retroperitoneal postchemotherapy mass involving the renal hilum. It was surgically removed via en bloc resection and bench ex vivo nephron-sparing surgery, and subsequently autotransplantation, thereby avoiding the necessity of nephrectomy and the resulting risk of chronic kidney disease. The pathology of the excised specimen demonstrated mixed germ cell tumor, composed of immature teratoma and yolk sac tumor, and confirmed tumor-free margins. CONCLUSIONS: This technique should be taken into account in selected patients as an alternative to radical nephrectomy when a retroperitoneal tumor is unresectable using standard surgical techniques or when a radical nephrectomy is considered, especially in patients with chronic kidney disease or solitary kidney, or in young patients who will potentially need nephrotoxic chemotherapy.
Collapse
Affiliation(s)
- Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain.
| | - Victoria Gómez Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Vital Hevia Palacios
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Inés Laso García
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Inés Rivero Belenchón
- Urology and Nephrology Department, Virgen del Rocío University Hospital, Seville, Spain, Biomedical Institute of Seville (IBiS)
| | - Gorka Gómez Ciriza
- FABLAB, Biomedical Institute of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | - Marta Santiago González
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Marina Mata Alcaraz
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Rafael Medina López
- Urology and Nephrology Department, Virgen del Rocío University Hospital, Seville, Spain, Biomedical Institute of Seville (IBiS)
| | - Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| |
Collapse
|
4
|
Li F, Zhou J, Chen S, Ji Z, Xie Y, Zeng R, Chen Y, Zheng Y. Blood Pressure Control and Renal Function Preservation of ex vivo Renal Artery Repair with Orthotopic Renal Autotransplantation for Complex Renal Artery Diseases. J Vasc Surg 2022; 76:1588-1595.e1. [DOI: 10.1016/j.jvs.2022.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/31/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
|
5
|
Renal Artery Repair with Kidney Autotransplantation for Renal Artery Aneurysms. Eur J Vasc Endovasc Surg 2022; 63:732-742. [DOI: 10.1016/j.ejvs.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/22/2021] [Accepted: 01/16/2022] [Indexed: 11/19/2022]
|
6
|
Contarini E, Takagi K, Kimenai HJAN, Ijzermans JNM, Furian L, Rigotti P, Minnee RC. Kidney Autotransplantation for Renal Artery Aneurysm: Case Series and a Systematic Review. Ann Vasc Surg 2021; 77:349.e5-349.e18. [PMID: 34437957 DOI: 10.1016/j.avsg.2021.05.039] [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: 11/12/2020] [Revised: 04/10/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Renal artery aneurysm (RAA) is a rare vascular disease. Kidney autotransplantation (KAT) is the treatment option when endovascular approach is not available. However, the evidence on KAT for RAA is mostly limited to small case series or reports. Here, we describe our 2 center experience of KAT for RAA, and provide the results of our systematic literature review to evaluate the outcomes. METHODS A retrospective 2 center study was conducted in patients undergoing KAT for RAA between 2010 and 2018. Moreover, a systematic review was performed on medical databases to evaluate the outcomes of KAT for RAA. RESULTS Nine patients were surgically treated at our institutions: eight with laparoscopic nephrectomy (LN), and 1 with open followed heterotopic KAT. All RAAs were ex-vivo reconstructed, and in 3 cases a vein graft was used for reconstruction. There were 2 postoperative major complications including 1 graft loss. In the systematic review, 102 studies with 355 patients were included. In 35 patients (9.9%) a minimal invasive approach was performed. The incidence of postoperative major complications and graft loss was 9.4% and 4.1%. CONCLUSIONS Our experiences showed that laparoscopic approach for nephrectomy followed heterotopic KAT was feasible with good postoperative outcomes. KAT is an effective treatment for RAA when endovascular approach is not feasible for interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.
Collapse
Affiliation(s)
- Emanuele Contarini
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Kosei Takagi
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Hendrikus J A N Kimenai
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Robert C Minnee
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Kidney Autotransplantation for Treatment of Ureteric Obstruction: A Case Report and Brief Review of the Literature. Case Rep Surg 2021; 2021:6646958. [PMID: 34336349 PMCID: PMC8321762 DOI: 10.1155/2021/6646958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/11/2021] [Indexed: 12/19/2022] Open
Abstract
Autologous kidney transplantation is a relatively rare procedure that has been used as an alternative treatment for a variety of complex genitourinary problems, in particular for the treatment of complex proximal ureteral strictures. In this case report, a 47-year-old male, who had undergone a living donor nephrectomy 14 years earlier, presented with episodes of acute kidney injury on chronic kidney disease. He was found to have a complex proximal ureter stricture of his solitary right kidney. He underwent nephrectomy with subsequent autotransplantation of the kidney into the right iliac fossa. His renal function improved significantly after surgery. Renal autotransplantation may be considered for the management of proximal ureteral obstruction when alternative options are contraindicated.
Collapse
|
8
|
Baitman T, Miroshkina I, Gritskevich A, Teplov A, Zotikov A, Kochetov A, Demidova V, Chupin A, Stepanova Y, Schima W, Karmazanovsky G. Extracorporeal Partial Nephrectomy with Orthotopic Autotransplantation under Pharmaco-Cold Ischaemia for Cancer of a Single Kidney: A Case Report. Case Rep Oncol 2020; 13:1202-1208. [PMID: 33173486 PMCID: PMC7590767 DOI: 10.1159/000510404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022] Open
Abstract
Up to 10% of patients with renal cell carcinoma (RCC) have locally advanced disease with venous tumour thrombosis involving the inferior vena cava (IVC). 30–50% of them present with synchronous metastatic disease. Surgical treatment remains the only potentially radical method for patients suffering from RCC and IVC tumour thrombosis without distant metastases. Five-year cancer-specific survival for such patients is 40–60%. The role of surgery in the treatment of RCC is significant, even if only cytoreductive operation is possible. Nephron-sparing surgery (NSS) is reasonably preferable for patients suffering from single kidney RCC, but it is not always radical enough. Extracorporeal approach allows to perform a radical dissection of the tumour in special complicated cases, but it is seldom used because of technical difficulties. We present a case of successful NSS by extracorporeal approach in our modification for RCC with IVC tumour thrombosis.
Collapse
Affiliation(s)
- Tatiana Baitman
- Department of Urology, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Irina Miroshkina
- Department of Urology, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Alexander Gritskevich
- Department of Urology, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Alexander Teplov
- Department of Urology, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Andrey Zotikov
- Department of Vascular Surgery, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Alexander Kochetov
- The Urology Center of A.A. Vishnevsky III Central Military Clinical Hospital, Moscow, Russian Federation
| | - Valentina Demidova
- The Department of Laboratory Diagnostics, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Andrey Chupin
- Department of Vascular Surgery, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Yulia Stepanova
- The Department of Ultrasound Diagnostics, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Wolfgang Schima
- The Department of Diagnostic and Interventional Radiology, Göttlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and St. Josef Krankenhaus, Vinzenzgruppe, Vienna, Austria
| | - Grigory Karmazanovsky
- The Department of Radiology, A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| |
Collapse
|
9
|
Bansal A, Kumar A, Maheshwari R, Desai P, Chaturvedi S, Dassi V. Renal autotransplant for major ureteric loss: Results from median 11 years of follow-up. Turk J Urol 2020; 47:151-157. [PMID: 33085605 DOI: 10.5152/tud.2020.20371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Renal autotransplant (RA) is an underutilized procedure to treat major ureteric loss. Studies on long-term outcomes and follow-up after RA are scarce. This study aimed to report the long-term outcomes and follow-up after RA. MATERIAL AND METHODS We identified 9 patients, from 2007 to 2019, who underwent RA after major ureteric loss (where direct restoration of continuity was not possible). We collected data regarding the etiology of ureteric loss, preoperative differential renal function, method of nephrectomy (laparoscopic or open), method of anastomosing the residual ureter/pelvis to the bladder, postoperative complications, duration of hospital stay, and renal function and drainage postoperatively and until the last follow-up. Changes in renal function and/or any obstruction to urinary drainage of the ipsilateral kidney postoperatively or during follow-up were measured. The Wilcoxon matched-pairs signed-rank test was used to compare the mean creatinine values preoperatively, postoperatively, and at last follow-up (p<0.05 was considered statistically significant). RESULTS All the patients had uneventful intraoperative and postoperative periods. The mean hospital stay was 6.4 (5-8) days. The median follow-up was 132 (46-156) months. The mean preoperative serum creatinine level was 1.0 (0.7-1.7) mg/dL. The mean creatinine value postoperatively and at last follow-up had no significant difference with preoperative value (p=0.96 and 0.75, respectively). The postoperative diethylene triamine pentaacetic acid scan demonstrated good perfusion and drainage. There was no deterioration of renal function or drainage during the follow-up. CONCLUSION RA is an excellent modality to treat major ureteric loss. It preserves renal function and avoids the problems related to bowel interposition and the need for long-term follow-up.
Collapse
Affiliation(s)
- Amit Bansal
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Anant Kumar
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Ruchir Maheshwari
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Pragnesh Desai
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Samit Chaturvedi
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| | - Vimal Dassi
- Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India
| |
Collapse
|
10
|
Zanettini LA, Zanettini LFS, Paulmichl A, Zanettini AC. Solitary kidney and thirteen (13) tumors: Laparoscopic radical nephroureterectomy, bench ex-vivo nephron-sparing surgery and auto-transplantation. Int Braz J Urol 2020; 46:1102-1105. [PMID: 32822142 PMCID: PMC7527098 DOI: 10.1590/s1677-5538.ibju.2019.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Alan Paulmichl
- Serviço de Urologia, Unimed Nordeste, Caxias do Sul, RS, Brasil
| | | |
Collapse
|