Editorial Comment to Successful third renal transplantation in a child with an occluded inferior vena cava: A novel technique to use the venous interposition between the transplant renal vein and the infrahepatic inferior vena cava

Abstract

Editorial Comment to Successful third renal transplantation in a child with an occluded inferior vena cava: A novel technique to use the venous interposition between the transplant renal vein and the infrahepatic inferior vena cava As a consequence of prior femoral central venous catheters, hypercoagulable disorders, trauma or other circumstances, an occluded inferior vena cava challenges the technique of renal transplantation when the iliac anatomy is unsuitable, especially for venous anastomosis. However, when these patients suffer from uremia, they should not be excluded from renal transplantation, which might be lifesaving, because they have exhausted the hemodialysis access. The operation can be accomplished successfully with excellent outcomes under deliberate preoperative vascular evaluation and creative surgical skill.Low-pressure venous drainage is required to allow adequate outflow from the allograft, so placing the graft distal to the thrombosis is not recommended, as it might negatively influence renal function. 1 Some prefer to use the native renal vein and place the kidney orthotopically, but an ipsilateral nephrectomy is required simultaneously. 2 We previously reported a case in which the dilated right spermatic cord vein was utilized for venous drainage in a patient with congenital hypoplasia of the inferior vena cava. 3 Others have directed to the portal system. Splenic vessels or the inferior or superior mesenteric vein have been reported for venous drainage, and good results were achieved. 1,4,5 In the present study, Muramatsu et al. described a novel technique for extension of the renal vein using the ovarian and large saphenous vein vertically incised and sutured into a certain diameter for an adultto-child live transplantation with an occluded inferior vena cava. 6 The successful outcome might be very helpful to surgeons who treat similar cases. However, without using the Endo GIA (cutting margin 1.2 cm) to cut the renal vein, the half-length of the left ovarian vein (half cut and joined, 4 cm) might be long enough to anastomose, which would decrease the duration of the surgical procedure. The long-term patient survival with good patency of the reconstructed renal vein requires further observation.