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Schematic view shows (inset) proximal anastomosis between the donor's common iliac artery (CIA) and the recipient's EIA. Distal anastomosis was performed between the recipient's and donor's external iliac artery (EIA).
Source publication
Atherosclerosis is common in patients with end-stage renal disease. Severe calcification of the iliac vessels is expected in the growing pool of kidney transplant candidates. Thus, transplant surgeons must constantly develop alternative operative strategies to deal with the technical challenges that this condition confers. This case report aims to...
Context in source publication
Context 1
... vascular allograft of sufficient length was prepared to bridge the gap created, suturing close to the take-off of the internal iliac artery. End-to-end anastomoses were performed between the vascular graft and both ends of the recipient's EIA (Fig 2). Finally, the kidney allograft was anastomosed to the interposition vascular graft and the recipient's external iliac vein in a termino-lateral fashion (Fig 3). ...
Citations
... After the bypass was in place, an end-to-side renal artery to prosthetic graft anastomosis was performed resulting with adequate perfusion for both the lower limb and the allograft. There are only 14 literature reports of intraoperative iliac artery dissection during kidney and/or pancreas transplantation procedure (7)(8)(9)(10)(11)(12)(13)(14). The most used reconstruction technique is synthetic vascular graft (seven cases) (9,11,12), while other methods are implemented less frequently: donor iliac artery graft (four cases) (13), endarterectomy (one case) (7), endarterectomy followed by subsequent endovascular stenting (one case) (14) and recipient saphenous vein graft (one case) (10). ...
... As in most reported cases, the bypass in our case was performed with a synthetic vascular prosthesis, and this has proven to be a good choice because synthetic grafts in this location have satisfactory long-term patency. Reported short term transplant and limb revascularization outcomes are excellent with reports of 100% 1-year kidney survival rate without major vascular issues (7)(8)(9)(10)(11)(12)(13)(14). The longest follow-up of a patients with simultaneous pancreas and kidney transplant is 45 months, reported by Moon et al. (13). ...
Intraoperative iliac artery dissection during kidney transplantation is a rare but serious complication that requires prompt intervention. We present a case of right external iliac artery dissection during deceased donor kidney transplantation. A 57-year-old male patient underwent standard pretransplant evaluation and had no signs of either significant aortoiliac occlusive disease or peripheral arterial occlusive disease. Diabetic nephropathy, arterial hypertension and smoking were the underlying causes of the patient’s end-stage renal disease. Transplantation was performed in the standard fashion. The kidney was positioned in the right iliac fossa and the venous end to-side anastomosis was performed first. A significant dissection of the right external iliac artery was found on arteriotomy. Immediate ilio-femoral bypass with a vascular prosthesis was performed. During two years of follow-up the kidney function is stable and there are no signs of lower limb vascular insufficiency.
For patients that return to dialysis after failed kidney transplantation, re-transplantation is safe, effective, and associated with a substantial mortality benefit compared to long-term dialysis [1]. Subsequent transplants, however, present additional immunologic and technical challenges, which may lead to increased complication rates and shorter graft survival [2, 3]. Here, we focus on the anatomic and surgical considerations in the setting of kidney re-transplant.KeywordsKidney re-transplantSurgical challengesIndications of nephrectomy
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 post-transplant events such as rejection, viral illness (BK Virus), recurrent disease (FSGS), and PTLD 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.
Background
Double kidney transplantation allows the use of marginal kidneys with a significant improvement in the recovery of renal function expected after transplantation, although with a greater anesthesiologic and surgical risk. One-sided positioning, more cautious in the event of functional exhaustion, can be complex due to vascular anomalies.
Materials and methods
We report the case of 2 double unilateral kidney transplants with vascular reconstructions.
The first is a double kidney transplant from a 83-year-old donor. Both kidneys (score 5) had 2 arteries and the arterial patch was not usable. A cryopreserved arterial graft was used for the packaging of an arterial axis with which a single T-L anastomosis was performed; the 2 veins were also joined with the packaging of a single anastomosis.
The second case is a double kidney transplant from a cadaveric donor performed on a recipient suffering from severe diffuse atheromasia. The right kidney had 2 arteries and the left kidney had 3 arteries (both score 5). The aortic patches and veins of the 2 kidneys were joined together and a single arterial and venous anastomosis was performed.
Results
The course has been uneventful. In both cases there were no perioperative vascular complications.
Conclusions
The use of marginal organs is an increasingly common reality. Bench vascular reconstructions can further increase donation resources, safely enhancing the transplantation of already marginal organs that would otherwise not be usable and allowing the contralateral vascular axis to be kept intact.
Background
A short right renal vein (RRV) remains a challenge for renal transplant surgery, especially in the living donor. Different techniques exist to obtain an RRV with a suitable length in cadaveric donor; however, in living donors the options are limited.
Material and Methods
We present 2 living kidney transplants in which we obtained a very short RRV, making the implantation very difficult. We describe our technique to overcome this problem by using cadaveric iliac vessels retrieved from previous cadaveric donations and preserved at 4°C in histidine-tryptophan-ketoglutarate (HTK) solution, without intraoperative or postoperative complications. We complied with the Helsinki Congress and the Istanbul Declaration regarding the donor source.
Results
In both cases, kidney grafts had optimal primary function, with good creatinine clearance after transplant and good patency of vascular anastomosis by Doppler ultrasounds.
Conclusions
We believe the use of cadaveric vessel grafts in living donor kidney transplant is a valuable resource as a rescue tool in emergency situations like the ones being presented in this article in order to avoid discarding a kidney graft with damage or short vessels.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
