Role of Synthetic Mesh Renorrhaphy and Neocapsule Reconstruction to Salvage Posttransplant Severely Damaged Renal Allografts

Neocapsular reconstruction for challenging partial nephrectomy: A feasibility study in a porcine model and recent clinical experience

“…The postoperative course was uneventful and several months later the serum creatinine level was 1.55 mg/dL (GFR = 54 mg/mL/1.73 m 2 ). This neocapsular approach was adopted in part from a recent publication and also supported by our experience with the first four animals included in this series of experiments 11 . (b) A 54‐year‐old man was also managed with neocapsular reconstruction 2 months after completion of our animal experiments.…”

“…While our studies were ongoing, a clinical report describing a similar reconstructive approach using Vicryl mesh was published, 11 and we had a transplant patient with a persistently bleeding allograft related to capsular damage that was also reconstructed in a similar manner. We also recently used the neocapsular reconstruction successfully after PN in a challenging situation.…”

“…Two patients had normal graft function 3 and 7 years after transplant, one experienced graft loss 7 years after transplant, and the final patient was in good standing but lost to follow‐up at 1 year. Synthetic mesh did not preclude or complicate graft biopsy and they did not observe long‐term complications associated with the mesh 11 . We also used the neocapsular approach successfully for a patient with capsular damage to the allograft with recurrent and otherwise unmanageable bleeding, and prophylactically for a patient undergoing PN for multifocal RCC with eight tumors removed leading to substantial capsular loss.…”

“…If the capsule cannot be reconstructed, there will be increased risk of postoperative bleeding and loss of additional parenchyma and function (Figure 1). 9 Capsular damage can also occur during procurement of kidneys for transplantation or due to renal trauma, leaving the surgeon in a similar perilous situation 10,11 . To address such challenges, our objective was to develop a neocapsule reconstruction technique using readily available natural thrombogenic materials that would provide tamponade and thus reduce the risk of postoperative venous bleeding.…”

“…While our study was in progress, a clinical report was published regarding four renal transplants with irreparable capsular damage, describing salvage of all allografts with a neocapsular approach using mesh 11 . At about that time, our transplant team encountered a challenging allograft with capsular damage that occurred during procurement, which was also salvaged through neocapsular reconstruction (Figure 2a).…”