Indications for and results of renal autotransplantation

Abstract

Purpose of reviewTo understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. Recent findingsRenal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) --though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists.

Therapeutic Donor Kidney Transplant Outcomes: Comparing Early US Experiences Using Optimal Matching

“…For centers interested in these types of transplants, multidisciplinary collaboration with the providers who have been caring for the patient considering therapeutic nephrectomy is beneficial. 13,19,22 Such patients have typically undergone extensive evaluations for their conditions, sometimes including direct GFR measurement and split kidney function testing. When available, these data can help facilitate patient counseling about nephrectomy alone versus autotransplantation as well as appropriate recipient selection if TD-KT is ultimately pursued.…”

“…[19][20][21] However, success rates differ between underlying diseases, with loin pain hematuria syndrome having the highest autotransplant graft success rate of 92%-100%, presumably because of the lack of structural abnormalities. 13,22 Mortality is generally low; however, postoperative complications are frequent (40%-50%), including hemorrhage, urinary tract infection, ureteral stricture, and graft thrombosis. 19,20 As such, additional studies that include detailed background information on the indications for nephrectomy are needed to further evaluate the potential risks associated with TD-KT.…”

“…In kidney autotransplantation, the affected kidney is removed, repaired/prepared on the back table in the operating room, and then reimplanted into the same patient, usually in the pelvis. 13 When autotransplantation is contraindicated because of anatomy or other surgical concerns, or the patient refuses autotransplantation because of its associated risks and opts for nephrectomy alone, TD-KT may be an option over simply discarding an otherwise transplantable kidney. 4 Indications for kidney autotransplantation include renovascular disease, ureteral stricture and trauma, excisable malignancy in the kidney and/or urinary tract, and loin pain hematuria syndrome.…”

Current status and future perspectives on robot‐assisted kidney autotransplantation: A literature review

“…It has also been used for LPHS, NCS, retroperitoneal fibrosis, and refractory urolithiasis due to metabolic stone disease. 11,20 Table 2 shows a summary of the literature on the indications for RAKAT. [8][9][10][11][12][13][14][15][16][17][18][19] To the best of our knowledge, a total of 86 cases were previously reported of heterotopic RAKAT, and no cases undergoing orthotopic RAKAT were reported.…”

“…Robot-assisted laparoscopic approaches can improve the perioperative outcomes of KAT and increase the use of RAKAT in various centers worldwide. 20 Despite this perspective, the number of reports on the procedure has surprisingly not increased over time. There are several limitations to RAKAT.…”