Current opinions in horseshoe kidney transplantation

Abstract

Currently, horseshoe kidneys are also being considered for transplantation due to the shortage of organs. They can be transplanted en bloc or after division of the renal isthmus. However, because of their low incidence, horseshoe kidneys are rarely transplanted. The considerable variation in vascular anatomy of the horseshoe kidney add to both the frequency of primary non-function and the technical difficulty of the transplantation. In the study reported here, the surgical members of the European Society for Organ Transplantation were asked for their opinions regarding the techniques and results of horseshoe kidney transplantation. Most surgeons advised explanting the horseshoe kidney en bloc. The decision to transplant en bloc or after division of the renal isthmus depended on the morphology of the renal isthmus, the number and position of renal vessels and/or the anatomy of the urinary collecting system. Most surgeons thought that the results of horseshoe kidney transplantation were equal to those of normal kidneys.

Horseshoe Kidney Transplantation

“…2 Horseshoe kidneys can be transplanted either into a single recipient en bloc or after division of the renal isthmus or into two recipients after division. 2,3 We present a case of a 53-year-old woman with endstage renal disease secondary to interstitial fibrosis who had been maintained on hemodialysis for 3 years and was admitted to our center for a kidney transplantation. The donor was a 77-year-old man with a medical history of hypertension who died as a result of intracerebral hemorrhage.…”

“…The number of patients awaiting a kidney transplant continues to rise. 2 Organs previously deemed unacceptable for transplant are being used with increased regularity exposing surgeons to new technical 3,4 and ethical challenges. Because of the technical challenge, horseshoe kidney transplantation should remain in experienced hands.…”

“…Because of the technical challenge, horseshoe kidney transplantation should remain in experienced hands. 3 Case reports have been published on techniques and outcomes with good results, similar to those of nonhorseshoe kidneys, if careful attention is paid to the anatomic variations. 1,4 Vascular anatomy of horseshoe kidneys is usually complex regarding the number as well as the origin of the renal arteries and veins.…”

“…1 Horseshoe kidneys can be transplanted en bloc or after dividing the renal isthmus. 2,3 The former method is technically similar to the en bloc kidney transplantation of pediatric kidneys into adult recipients. The decision to transplant a horseshoe kidney en bloc depends on several factors, including age of the donor, renal isthmus morphology, and vascular anatomy.…”

“…4 To compensate the decreased number of functional nephrons with age, en bloc or dual graft transplantation of kidneys from older donors, like in this case, has been suggested. [2][3][4] Another factor determining the transplant type of a horseshoe kidney is the anatomic structure of the urinary collection system, because during separation of a fused renal isthmus, 4 the urinary collection system can be injured and a urinary fistula can result.…”