Kidney transplantation from living donor with monolateral renal artery fibromuscular dysplasia using a cryopreserved iliac graft for arterial reconstruction: a case report and review of the literature

Abstract

Background Aging and mortality of patients on waiting lists for kidney transplantation have increased, as a result of the shortage of organs available all over the world. Living donor grafts represent a significant source to maintain the donor pool, and resorting successfully to allografts with arterial disease has become a necessity. The incidence of renal artery fibromuscular dysplasia (FMD) in potential living renal donors is reported to be 2–6%, and up to 4% of them present concurrent extra-renal involvement. Case presentation We present a case of renal transplantation using a kidney from a living donor with monolateral FMD. Resection of the affected arterial segment and its subsequent replacement with a cryopreserved iliac artery graft from a deceased donor were performed. No intraoperative nor post-operative complications were reported. The allograft function promptly resumed, with satisfying creatinine clearance, and adequate patency of the vascular anastomoses was detected by Doppler ultrasounds. Conclusion Literature lacks clear guidelines on the eligibility of potential living renal donors with asymptomatic FMD. Preliminary assessment of the FMD living donor should always rule out any extra-renal involvement. Whenever possible, resection and reconstruction of the affected arterial segment should be taken into consideration as this condition may progress after implantation.

Transplantation of 2-Month-Old En Bloc Pediatric Kidneys After a Complex Vascular Reconstruction – Traveling 2500 Miles to Get Transplanted: A Case Report

“…Although there are few reports of back-table EBPK reconstruction and transplantation with good graft function previously published [ 7 , 25 – 27 ], all these reports agree on the crucial role of using a meticulous technique during the vascular reconstruction [ 7 , 25 – 27 ], which, in the light of the results obtained in this case, we also recognize as essential.…”

Case Report: The Use of Cryopreserved Saphenous Vein in Reconstruction of Transplant Renal Artery Dissection

“…19,20 In the transplant setting, there has been documented use in solid organ transplants, with several studies demonstrating its use in portal vein reconstruction, cryopreserved iliac artery for renal artery and vein reconstruction, and other reports. [21][22][23][24] A more recent study showed the successful use of cryopreserved allografts in renal vessel extension in living donor kidney transplants without late vascular complications. 25 Despite these studies, a major concern is that because cryopreservation preserves living cells, donor endothelium is subject to both cell-and antibody-mediated rejection, [26][27][28][29] which may contribute to a high failure rate.…”

The use of polytetrafluoroethylene graft for damaged renal artery in ABO-incompatible living donor kidney transplantation: a case report

“…On the other hand, renal vessels from living donor kidney allografts are relatively shorter than those from deceased donors; therefore, injury to these vessels often pose a serious challenge. Cryopreserved vascular allografts can be used for renal vascular reconstruction in cases of renal arterial abnormalities in allograft kidneys [ 10 ]. However, it is only to be used for cases in which the abnormal vasculature in the donor’s kidney is diagnosed before LDKT.…”