Orthotopic Renal Transplantation in a Patient With a Massive Pelvic Arteriovenous Malformation

Ferri, Melanie; Russell, J. David; Whelan, J. Paul

doi:10.1016/s0022-5347(05)67831-7

Cited by 9 publications

(4 citation statements)

References 2 publications

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“…The improvement in immunosuppression which provides long-lasting organ function also promotes long-lasting survival for patients, allowing them the chance of a second, third or even more transplants. In some patients in whom the fossa might be unsuitable due to multiple anterior dissections, previous fi brotic transplanted organ occupying the fossa, pelvic malformations [3] , vena cava thrombosis [4] or obstructive disease of the iliac arteries, there is a need for alternative surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Alternative Grafting Technique for Patients Unsuited to Heterotopic Transplantation due to Diseased Pelvic Conditions

Rodrigues¹,

D'Império²,

Campagnari³

et al. 2004

Urol Int

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Introduction: An alternative technique for kidney transplantation is presented for patients in whom the use of pelvic vessels is precluded. Patients and Methods: Of 482 cases of kidney or pancreas-kidney transplants, 4 were unsuited to heterotopic grafting, 1 due to multiple operations in the fossae and the 3 others due to extensive vascular occlusive disease. The patients were studied preoperatively by magnetic resonance angiography, which revealed extensive occlusive disease of the distal aorta and/or iliac vessels. Results: The patients received kidneys from living related donors as a third or second transplant opportunity in the orthotopic position (2 cases). Gross dissection of the aorta revealed a thickened wall, impeding direct anastomoses between the recipient’s arteries and the donated organ. After a termino-lateral Dacron graft to the aorta, all cases were stented for uretero-uretero anastomosis. Recovery with respect to the renal graft was uneventful for all cases. Conclusions: Alternative direct grafting from the aorta represents a viable and easy way to perform kidney transplants in patients unsuited to the heterotopic approach.

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Section: Discussionmentioning

confidence: 99%

Alternative Grafting Technique for Patients Unsuited to Heterotopic Transplantation due to Diseased Pelvic Conditions

Rodrigues¹,

D'Império²,

Campagnari³

et al. 2004

Urol Int

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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: 86%

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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“…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. 15–18 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: 89%