Horseshoe kidney transplantation: an overview

Abstract

The horseshoe kidney is the most common anatomical renal variation. It represents a fusion anomaly, mainly at the lower poles, occurring between the 4th and 6th week of gestation. Horseshoe kidneys display a great variation in origin, number and size of the vasculature. Transplantation of these deviant kidneys can be done en bloc or they can be split into two halves and transplanted into two recipients, depending on the number of vessels and the anatomy of the urinary collecting system. A literature review reveals 31 case histories, published between 1975 and 1998. Of these 21 were transplanted into 38 recipients after division and ten were implanted en bloc. Nineteen grafts (41%) showed immediate function and 21 grafts (46%) showed delayed function. Thrombosis and acute rejection, leading to non-function was seen in six grafts (13%). The overall success rate was 87%) with a mean follow-up of 22 months. The results of horseshoe kidney transplantation are good. provided that attention is paid to certain technical details. Because of donor scarcity, horseshoe kidneys should be used for transplantation.

Current opinions in horseshoe kidney transplantation

“…A total of 31 cases of horseshoe kidney transplantation have been described in the literature [5]. Because of the technical challenge involved in transplanting this type of kidney and their low frequency, some surgeons seem to be reluctant to use horseshoe kidneys for transplantation.…”

“…Most surgeons (7 1.4%) consider the post-transplant results of horseshoe kidneys to be equal to those of kidneys with a normal anatomy. A literature review shows that this is most likely [5]. Some surgeons (23.2%) think the posttransplant results of horseshoe kidneys are worse than those of normal kidneys.…”

Horseshoe Kidney Transplantation: An Underpowered Source for Kidney Allografts, Review and Case Report

“…The position of the allograft into the recipient can also variate, and orientation must be checked to avoid kinking or vascular stretching. Decision about en bloc transplantation or separating the two renal moieties and transplanting into two recipients must consider both allograft and recipient variables, such as vascular anatomy, technical feasibility to separate the two kidneys, graft size, and donors anatomy (2,8).…”

“…The horseshoe kidney is a result of an accidental fusion of the ureteral buds between the sixth and fourth week of gestation (2). Although most horseshoe kidneys are fused in the lower pole, less than 5% are through the upper pole.…”

Horseshoe kidney transplantation

“…The kidney functioned well, but the recipient died 8 months later of hepatitis [8]. Horseshoe kidneys can be transplanted en bloc or separated fi rst and then transplanted separately [9]. Marofka et al performed horseshoe kidney transplantation in 2000 fi rst, and in 2003, the second time.…”