Renal Artery Repair with Kidney Autotransplantation for Renal Artery Aneurysms

Ramouz, Ali; Hafezi, Mohammadreza; Ali-Hasan-Al-Saegh, Sadeq; Shafiei, Saeed; Dezfouli, Sepehr Abbasi; Probst, Pascal; Demirel, Serdar; Böckler, Dittmar; Mehrabi, Arianeb

doi:10.1016/j.ejvs.2022.01.015

Cited by 7 publications

(13 citation statements)

References 85 publications

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“…The ex vivo approach facilitates access and visualization in a bloodless field, thereby optimizing the removal of centrally-located renal tumors or reconstruction of small vascular branches (patency rates 82–99%) [9,10]. The kidney is most commonly replaced in the iliac fossa (i.e., heterotopic autotransplant) and less so in the original renal fossa (i.e., orthotopic autotransplant); orthotopic RA is reserved for cases with a previously occupied iliac fossa or severe iliac atherosclerosis [11 ▪ ,12–15]. The ureter may be preserved or reimplanted based on RA indication [10,16,17].…”

Section: Operative Approachmentioning

confidence: 99%

“…Fabrizio et al [18] and Gill et al [19] described the first transabdominal and retroperitoneal laparoscopic nephrectomies for RA in 2000. Hospital lengths of stay were shorter among RA patients who had laparoscopic compared to open nephrectomies prior to open autotransplantation (6.3 vs. 10.3 days, P = 0.042) [11 ▪ ]. In 2014, Gordon et al [20] reported the first completely intracorporeal robotic RA in a patient with necrotic ureter loss from failed ureteroscopy.…”

Section: Operative Approachmentioning

confidence: 99%

“…Complex renovascular disease not amenable to endovascular repair (ex. hilar aneurysms with multiple parenchymal branches) remains the most common indication for RA – accounting for 22.7% of cases [4]; etiologies include fibromuscular dysplasia, atherosclerosis, Takayasu's Arteritis, complex aortic or renal artery or renal vein aneurysms, renal artery stenosis, and Nutcracker Syndrome [10,11 ▪ ,29–32]. Renal function is generally preserved or improved after RA [10,11 ▪ ,33,34].…”

Section: Renovascular Diseasementioning

confidence: 99%

“…The efficacy of RA in treating hypertension secondary to renovascular disease is favorable but mixed [10,14,17,29,31,32]. A recent systematic review reports that after RA for renal artery aneurysms, only 56% of patients had their hypertension cured or improved [11 ▪ ]; that said, among children undergoing RA for renovascular hypertension with 15-year mean follow-up, the long-term benefits were robust with all 16 patients either cured of hypertension or improved [43].…”

Section: Renovascular Diseasementioning

confidence: 99%

“…Complications range from 8% to 50% in recent large series and comprise of graft failure, vessel thrombosis, urine leak, anastomotic hemorrhage, and infection [4,11 ▪ ,78 ▪ ,91,101 ▪ ]. With graft failure rates at approximately 10% often from thrombotic events [4,64,78 ▪ ], suspicion for graft thrombosis should be high with prompt evaluation by CT, MRA, renal scintigraphy, contrast-enhanced US, or Color Doppler US to minimize time to treatment [70].…”

Section: Complicationsmentioning

confidence: 99%

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Indications for and results of renal autotransplantation

Han

Johnson

Schulster

et al. 2022

Current Opinion in Nephrology &Amp; Hypertension

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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.

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Section: Operative Approachmentioning

confidence: 99%

Section: Operative Approachmentioning

confidence: 99%

Section: Renovascular Diseasementioning

confidence: 99%

Section: Renovascular Diseasementioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

Indications for and results of renal autotransplantation

Han

Johnson

Schulster

et al. 2022

Current Opinion in Nephrology &Amp; Hypertension

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Ex vivo repair and autotransplantation for a complex renal artery aneurysm

Chui

Wang

Puttaswamy

2023

Journal of Surgical Case Reports

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Renal artery aneurysms (RAA) are rare, occurring with an incidence of <0.1%. Open repair remains the mainstay of treatment for anatomically complex aneurysms. Here, we present a case of a large hilar RAA managed with ex vivo reconstruction and heterotopic renal autotransplantation. In this case, the complex anatomy and location of the aneurysm precluded the use of an endovascular approach. In situ repair was deemed unfavorable because of the technical difficulty of the repair with the numerous arterial branches involved, risk of parenchymal injury from prolonged warm ischemic time, restricted surgical field and risk of aneurysm rupture. This case contributes to the literature on laparoscopic nephrectomy, ex vivo repair and autotransplantation as a safe and viable treatment strategy for patients with complex RAA.

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

Yamauchi,

Raghavan,

Rofaiel

et al. 2023

Transplantation Direct

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Background. Therapeutic donors (TDs) are individuals who undergo organ removal for medical treatment with no replacement organ, and the organ is then transplanted into another person. Transplant centers in the United States have started using TDs for kidney transplantation (KT). TD-KT recipient outcomes may be inferior to those of non-TD-living-donor (non-TD-LD)-KT or deceased-donor (DD)-KT because of the conditions that led to nephrectomy; however, these outcomes have not been sufficiently evaluated. Methods. This was a retrospective cohort study using Organ Procurement and Transplantation Network data. Via optimal matching methods, we created 1:4 fivesomes with highly similar characteristics for TD-KT and non-TD-LD-KT recipients and then separately for TD-KT and DD-KT recipients. We compared a 6-mo estimated glomerular filtration rate (eGFR) between groups (primary endpoint) and a composite of death, graft loss, or eGFR <30 mL/min/1.73 m2 at 6 mo (secondary). Results. We identified 36 TD-KT recipients with 6-mo eGFR. There was also 1 death and 2 graft losses within 6 mo. Mean ± SD 6-mo eGFR was not significantly different between TD-KT, non-TD-LD-KT, and DD-KT recipients (59.9 ± 20.7, 63.3 ± 17.9, and 59.9 ± 23.0 mL/min/1.73 m2, respectively; P > 0.05). However, the 6-mo composite outcome occurred more frequently with TD-KT than with non-TD-LD-KT and DD-KT (18%, 2% [P < 0.001], and 8% [P = 0.053], respectively). Conclusions. Early graft function was no different between well-matched groups, but TD-KT demonstrated a higher risk of otherwise poor 6-mo outcomes compared with non-TD-LD-KT and DD-KT. Our results support selective utilization of TD kidneys; however, additional studies are needed with more detailed TD kidney information to understand how to best utilize these kidneys.

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Renal Artery Repair with Kidney Autotransplantation for Renal Artery Aneurysms

Cited by 7 publications

References 85 publications

Indications for and results of renal autotransplantation

Indications for and results of renal autotransplantation

Ex vivo repair and autotransplantation for a complex renal artery aneurysm

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

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