Orthotopic Kidney Transplant: a Valid Surgical Alternative for Complex Patients

Hevia, Vital; Gómez, Victoria; Álvarez, Sara; Diez-Nicolás, V.; Fernandez, Armida; Burgos, Francisco

doi:10.1007/s11934-014-0470-x

Cited by 19 publications

(35 citation statements)

References 10 publications

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“…Two recent studies have recommended this technique for patients with advanced atherosclerosis disease of the iliac arteries, bilaterally retained iliac fossae from previous kidney transplants, pelvic malformations, venous thrombosis, and obesity. 1,2 The studies additionally described that the orthotopic technique is challenging, with a slightly higher complication rate. Nevertheless, the present case reveals that an almost orthotopic position between the right common iliac artery and the patient's liver is feasible in highly complicated cases with one of these indications.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] It remains arguable whether this is caused by poor vascularization due to an above-average length of the transplanted ureter. Two retrospective studies stated that the length of the transplanted ureter does not affect postoperative urologic complications, but these studies do not mention a ureter length exceeding 12 cm.…”

Section: Discussionmentioning

confidence: 99%

“…However, the technique is challenging, and the complication rate is slightly higher than with iliac vessel heterotopic transplants. 1,2 The major complications in renal transplant recipients are urologic problems in the posttransplant period, occurring with an incidence of around 3%, of which ureteric stenosis represents 25% to 30%. [3][4][5][6] The optimal surgical approach for reconstruction of such ureteric stenosis depends on the stricture's section.…”

Section: Introductionmentioning

confidence: 99%

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High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

Barański²

2019

Exp Clin Transplant

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The decision-making process for treatment of patients with end-stage renal failure, multiple failed renal transplants, and severe comorbidities can be exceedingly difficult due to the inapplicability of many common surgery methods. In this article, we report the treatment of such a patient who underwent a third renal transplant and subsequently developed a ureteral stenosis. The third kidney had been transplanted with a high abdominal position and a partially intra-and retroperitoneally placed ureter due to a bilaterally obtained iliac fossa and severe abdominal adhesions. For the severe ureteric stenosis, an alternative urinary tract reconstruction was developed by making use of the native ureter contralateral to the graft by tunneling under the sigmoid. We recommend this surgical method as a valid alternative for patients with severe ureteric graft stenosis, when treatment with stenting and common surgical ureter reconstruction methods are not feasible. Key words: Complex receptor, Constriction, End-stage renal disease, Orthotopic, Pathologic, Ureter IntroductionThe decision-making process to treat patients with end-stage renal disease and an extensive medical background, including multiple failed transplants and severe comorbidities, can be extremely difficult. In this article, we report the surgical treatment of such a patient who underwent a third renal transplant procedure and subsequently developed a ureter stenosis of the transplanted kidney.A common problem with multiple previous renal transplants is a bilaterally unavailable iliac fossa, making heterotopic transplant sometimes not suitable. In such cases, an orthotopic transplant is an alternative approach. Functional results, that is, patient and graft survival rates at 1, 10, and 20 years, are almost similar to heterotopic transplant procedures. However, the technique is challenging, and the complication rate is slightly higher than with iliac vessel heterotopic transplants. 1,2The major complications in renal transplant recipients are urologic problems in the posttransplant period, occurring with an incidence of around 3%, of which ureteric stenosis represents 25% to 30%. [3][4][5][6] The optimal surgical approach for reconstruction of such ureteric stenosis depends on the stricture's section. Because common surgical approaches or a fourth transplant are not always optimal, as for our present complicated case, an alternative approach for urinary tract reconstruction by anastomosis to the contralateral native ureter was developed. 6Case Report patient history A 22-year-old man was admitted to the hospital for a third transplant due to end-stage renal failure. His medical history included premature birth with perinatal asphyxia, spastic tetraplegia, mild mental retardation, and severe vertebral column scoliosis. He developed end-stage renal failure by perinatal asphyxia and dysplasia of the kidneys and a neuropathic bladder by tetraplegia. As a result of continuous infectious diseases, he received nephrectomy of both kidneys, without the remov...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

Barański²

2019

Exp Clin Transplant

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“…[17] However, the procedure is technically demanding and associated with high surgical complication rates (66.7%) when performed infrequently. [18] 3. How should one approach the chronic haemodialysis patient in need of an FHC?…”

Section: In Practicementioning

confidence: 99%

Beware: The femoral haemodialysis catheter – a surgeon’s perspective

2017

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“… 2 Because of technical ease and success, the heterotopic renal transplantation (HRT) in the right or left iliac fossa is generally preferred over the orthotopic renal transplantation (ORT). 3 , 4 However, in selected patients where HRT is not possible, and so ORT was shown to be a desirable alternative. 3 …”

Section: Introductionmentioning

confidence: 99%

Simultaneous living donor orthotopic renal transplantation and bilateral nephrectomy for recurrent renal cell carcinoma and renal failure: case report and review of literature

Novotný

Marada

Chlupáč

et al. 2018

RRU

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BackgroundWe report the case of a 43-year-old female patient with systemic lupus erythematosus, class III lupus nephritis, with predialysis creatinine levels around 350 μmol/L (3.95 mg/dL) after partial resection of the left kidney with histologically verified papillary carcinoma in 2010. Preoperative computed tomography of the abdomen revealed a small 8 mm tumor in the left upper kidney pole. The patient was indicated for simultaneous bilateral nephrectomy and orthotopic renal transplantation with the aim to minimize invasiveness of the procedure as well as for curable tumor removal.MethodThe procedure was performed under the full anesthesia trough upper middle laparotomy. As the first step, bilateral transperitoneal nephrectomy was performed. The live donor surgery started in a parallel theater to shorten the cold ischemic time of the graft. The renal graft had singe vessels and ureter; it was placed into the recipient’s right orthotopic position. End-to-end anastomosis of the right renal vein and artery anastomosis were performed; ureter was anastomosed end-to-end using recipient’s ureter.ResultsThe postoperative period was uneventful with repeatedly excellent ultrasonography check-up of the graft’s perfusion. The patient was discharged after 13 days with a good renal function of the graft (urea: 15 mmol/L, creatinine 160 μmol/L [1.80 mg/dL]).ConclusionOrthotopic renal transplantation is a technically challenging but valid alternative for patients who are unsuitable candidates for heterotopic renal transplantation or in cases where there is a clear benefit of orthotopic renal transplantation.

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Orthotopic Kidney Transplant: a Valid Surgical Alternative for Complex Patients

Cited by 19 publications

References 10 publications

High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

Beware: The femoral haemodialysis catheter – a surgeon’s perspective

Simultaneous living donor orthotopic renal transplantation and bilateral nephrectomy for recurrent renal cell carcinoma and renal failure: case report and review of literature

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