Indication, Surgical Technique and Outcome of Orthotopic Renal Transplantation

Paduch, Darius A.; Barry, John M.; Arsanjani, Amir; Lemmers, Michael J.

doi:10.1016/s0022-5347(05)65645-5

Cited by 23 publications

(13 citation statements)

References 40 publications

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“…Open surgery for orthotopic kidney transplant has been reported in the literature as an effective alternative for those recipients in whom a heterotopic transplant was inappropriate, such as patients with a retained iliac fossa from a former graft, thrombosis of the iliac vein, or severe arthromatosis on the iliac artery. [15][16][17][18] The long-term patient and graft survival rates are comparable with those for conventional heterotopic kidney transplant. 18 However, open orthotopic kidney transplant has not been the favored approach because it is more difficult when compared with conventional heterotopic kidney transplant.…”

Section: Discussionmentioning

confidence: 87%

“…It usually requires a longer midline incision or use of a posterolateral lumbotomy, in which massive muscles will be cut. 17,18 As a result, more analgesia is required and the recovery takes longer. This study has shown that orthotopic kidney transplant can be performed safely by a laparoscopic ap- proach, in which only a small midline (6-cm) incision is needed.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

Mou

Musk

et al. 2012

Transplantation Journal

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Background and Objectives: Laparoscopic surgery has rapidly expanded in surgical practice with well-accepted benefits of minimal incision, less analgesia, better cosmetics, and quick recovery. The surgical technique for kidney transplantation has remained unchanged since the first successful kidney transplant in the 1950s. Over the past decade, there were only a few case reports of kidney transplantation by laparoscopic or robotic surgery. Therefore, the aim of this study is to develop a laparoscopic technique for kidney transplantation at the region of the native kidney.Methods: After initial development of the laparoscopic technique for kidney transplant in cadaveric pigs, 5 live pigs (Sus scrofa, weighing 45-50 kg) underwent laparoscopic kidney transplant under general anesthesia. First, laparoscopic donor nephrectomy was performed, and then the kidney was perfused and preserved with cold Ross solution. The orthotopic auto-transplant was subsequently performed using the laparoscopic technique. The blood flow of the kidney graft was assessed using Doppler ultrasonography, and urine output was monitored. Results:The laparoscopic kidney transplant was successful in 4 live pigs. Immediate urine output was observed in 3 pigs. The blood flow in the kidney was adequate, as determined using Doppler ultrasonography. Conclusion:It has been shown that laparoscopic kidney orthotopic transplant is feasible and safe in the pig model. Immediate kidney graft function can be achieved. A further study will be considered to identify the potential surgical morbidity and mortality after recovery in a pig model before translating the technique to clinical human kidney transplantation.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

Mou

Musk

et al. 2012

Transplantation Journal

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show abstract

“…It usually requires a longer midline incision or use of a posterolateral lumbotomy, in which massive muscles will be cut. 17,18 As a result, more analgesia is required and the recovery takes longer. This study has shown that orthotopic kidney transplant can be performed safely by a laparoscopic approach, in which only a small midline (6-cm) incision is needed.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

Musk

Mou

et al. 2013

JSLS

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“…The anastomosis of graft vessels in our patient to the lower abdominal aorta and vena cava was impossible due to extensive atheromatosis and venous thrombosis. Under these conditions an orthotopic kidney transplantation with anastomosing donor and recipient native vessels is well established [3–5] and had been previously performed in patients with an aortic occlusion, severe pelvic atherosclerosis, pelvic vascular anomaly, previews kidney transplantation, and urinary tract reconstruction [6]. …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-Assisted Recipient Nephrectomy and Recipient Kidney Procurement during Orthotopic Living-Related Kidney Transplantation

Mikhalski

Wissing

Bollens³

et al. 2011

Case Reports in Transplantation

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Advanced atherosclerosis or thrombosis of iliac vessels can constitute an absolute contraindication for heterotopic kidney transplantation. We report the case of a 42-year-old women with end-stage renal disease due to lupus nephritis and a history of bilateral thrombosis of iliac arteries caused by antiphospholipid antibodies. Occlusion had been treated by the bilateral placement of wall stents which precluded vascular anastomosis. The patient was transplanted with a right kidney procured by laparoscopic nephrectomy from her HLA semi-identical sister. The recipient had left nephrectomy after laparoscopical transperitoneal dissection. The donor kidney was orthotopically transplanted with end-to-end anastomosis of graft vessels to native renal vessels and of the graft and native ureter. Although, the patient received full anticoagulation because of a cardiac valve and antiphospholipid antibodies, she had no postoperative complication in spite of a short period of delayed graft function. Serum creatinine levels three months after transplantation were at 1.0 mg/dl. Our case documents that orthotopical transplantation of laparoscopically procured living donor kidneys at the site of recipient nephrectomy is a feasible procedure in patients with surgical contraindication of standard heterotopic kidney transplantation.

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Indication, Surgical Technique and Outcome of Orthotopic Renal Transplantation

Abstract: Despite the technical challenges, orthotopic renal transplantation in patients with unsuitable pelvic vessels can result in excellent patient and graft survival.

Cited by 23 publications

References 40 publications

Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

Laparoscopic-Assisted Recipient Nephrectomy and Recipient Kidney Procurement during Orthotopic Living-Related Kidney Transplantation

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