Eversion endarterectomy of the deceased donor renal artery to prevent kidney discard

Khan, Muhammad Arsalan; Hennawy, Hany M El; Jones, Korie C.; Harriman, David; Farney, Alan C.; Rogers, Jeffrey; Orlando, Giuseppe; Stratta, Robert J.

doi:10.1111/ctr.13275

Cited by 4 publications

(4 citation statements)

References 43 publications

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“…The artery was carefully flushed in an antegrade manner to check for patency, integrity, leaks, or disruption. The procedure had acceptable short-term outcomes and can be promising [22].…”

Section: Discussionmentioning

confidence: 91%

“…In our study, 64.2% of the vascular abnormalities behind RNTK were atheromatous lesions. Khan et al in 2018 suggested that eversion endarterectomy (EE) appears to be a safe procedure that can prevent discard of marginal donor kidneys exhibiting severe atherosclerosis involving the renal artery. After a subintimal dissection of the Carrel aortic patch surrounding the renal artery, a complete eversion was performed with a subsequent removal cast.…”

Section: Discussionmentioning

confidence: 99%

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Retrieved but not transplanted kidneys: how to limit the losses? A retrospective national study

et al. 2021

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Despite the organ shortage, a significant number of deceased donor kidneys are retrieved but not transplanted (RNTK). This study aims to describe and analyze the main causes of potential grafts discard and to propose adequate solutions. We collected data from the Cristal database of the French Biomedicine Agency about RNTK over one year. Expert opinion was taken from urologists with extensive expertise in renal transplantation. They retrospectively analyzed each record to assess the appropriateness of each graft refusal and subsequent kidney discard. Of 252 kidneys were retrieved but not transplanted in France over one year. The main reasons for discard were vascular abnormalities in 43.7% (n = 110), suspicion of malignant tumor in 18.7% (n = 47), and severe histological lesions on preimplantation biopsy in 12.3% (n = 31). The reason for kidney refusal was undetermined in 4.8% (n = 12). Iatrogenic lesions were responsible for 26.2% (n = 66). Overall, 46.0% (n = 16) and 25.0% (n = 63) of the grafts were, respectively, properly and improperly denied, and the analysis was not possible in 29.0% (n = 73). In total, 36.9% of RNTK could have been transplanted. Reduction of iatrogenic lesions, improvement of microsurgical repair skills, and proper histological examination are necessary to reduce the number of RNTK. A prospective study applying the proposed principles is undoubtedly essential to complete this work.

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“…The artery was carefully flushed in an antegrade manner to check for patency, integrity, leaks, or disruption. The procedure had acceptable short-term outcomes and can be promising [22].…”

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Retrieved but not transplanted kidneys: how to limit the losses? A retrospective national study

et al. 2021

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“…The presence of vascular hard stenotic plaques may imply a contraindication to deceased donor transplantation. Depending on the availability of the Carrel aortic patch, the location of hard stenotic plaque (involving ostium and extending into renal artery), length of plaque free renal artery (safe anastomosis generally requiring main renal artery 1.5 cm or longer), either resection of a segment of artery/ Carrel patch containing plaque (permitting end to side anastomosis in a similar fashion performed in living donor kidney transplantation) or eversion endarterectomy can be successfully performed as a rescue procedure but requires increased technical expertise [33].…”

Section: Discussionmentioning

confidence: 99%

The Independent Effects of Kidney Length and Vascular Plaque on Ten-Year Outcomes of Extended Criteria Donor Kidney Transplants

Tanrıöver

Stewart²,

Kamal

et al. 2023

Transpl Int

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The independent effects of deceased donor kidney length and vascular plaque on long-term graft survival are not established. Utilizing DonorNet attachments from 4,480 expanded criteria donors (ECD) recovered between 2008 and 2012 in the United States with at least one kidney biopsied and transplanted, we analyzed the relationship between kidney length and vascular plaques and 10-year hazard of all-cause graft failure (ACGF) using causal inference methods in a Cox regression framework. The composite plaque score (range 0–4) and the presence of any plaque (yes, no) was also analyzed. Kidney length was modeled both categorically (<10, 10–12, >12 cm) as well as numerically, using a restricted cubic spline to capture nonlinearity. Effects of a novel composite plaque score 4 vs. 0 (HR 1.08; 95% CI: 0.96, 1.23) and the presence of any vascular plaque (HR 1.08; 95% CI: 0.98, 1.20) were attenuated after adjustment. Likewise, we identified a potential nonlinear relationship between kidney length and the 10-year hazard of ACGF, however the strength of the relationship was attenuated after adjusting for other donor factors. The independent effects of vascular plaque and kidney length on long-term ECD graft survival were found to be minimal and should not play a significant role in utilization.

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“…As a result of the increasing number of ECD and of the aging of both donor and recipient population, atherosclerosis of the vascular axis of the graft and of the recipient is becoming a serious challenge in the field of organ transplantation (20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Iloprost in Acute Post-kidney Transplant Atheroembolism: A Case Report of Two Successful Treatments

et al. 2020

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Cholesterol embolization (CE) is a rare and alarming post-transplant complication, responsible for primary non-function (PNF) or delayed graft function (DGF). Its incidence is expected to rise due to increasingly old donors and recipients and the extended criteria for donation. Therapy with statins and steroids has not been shown to be effective, while agonism of prostaglandin I 2 has been reported to be useful in systemic CE. We report two cases of acute post-transplant CE in which intravenous iloprost (0.05 mg/kg/day) was added to standard statin and steroid therapy. In the first instance, CE was due to embolization from the kidney artery resulting in embolization of the small vessels; after a long DGF and 15 days of iloprost therapy, renal function recovered. The second instance is a case of embolization from the iliac artery of the recipient, where CE manifested as a partial renal infarction. After 5 days of iloprost administration, creatinine levels improved. Iloprost acts on vasodilation and on different inflammatory pathways, improving the anti-inflammatory profile. Post-transplant CE is difficult to diagnose and, if not treated, can lead to loss of function. Iloprost added to standard therapy could be beneficial in accelerating renal function recovery immediately after transplant.

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Eversion endarterectomy of the deceased donor renal artery to prevent kidney discard

Abstract: EE appears to be a safe and under-utilized procedure that may prevent discard of marginal donor kidneys and is associated with acceptable short-term outcomes.

Cited by 4 publications

References 43 publications

Retrieved but not transplanted kidneys: how to limit the losses? A retrospective national study

Retrieved but not transplanted kidneys: how to limit the losses? A retrospective national study

The Independent Effects of Kidney Length and Vascular Plaque on Ten-Year Outcomes of Extended Criteria Donor Kidney Transplants

Iloprost in Acute Post-kidney Transplant Atheroembolism: A Case Report of Two Successful Treatments

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