The inferior vena caval conduit - a neglected technique in transplantation of the right cadaveric kidney?

Abstract

A short right renal vein may reduce access or compromise optimal positioning during transplantation of the right cadaveric kidney. This difficulty could be overcome by using the inferior vena cava (IVC) as a venous conduit to lengthen the short right renal vein. This manoeuvre would also facilitate training by ensuring safe tension-free vascular anastomoses since the kidney can be lifted up a comfortable distance, thus improving exposure of the operative field. In a postal survey, only a third of UK renal transplant units utilised the IVC conduit. Despite 81.5% of units claiming that they harvest the IVC during organ retrieval, a 2-year retrospective audit revealed that only 4.3% of imported right kidneys had the IVC. The IVC remains a much under-utilised resource in the UK despite its potential benefit as a venous conduit in transplanting the right cadaveric kidney. We urge all retrieving surgeons to routinely harvest the IVC with right cadaveric kidneys during organ procurement.

Right renal vein elongation with the inferior vena cava for cadaveric kidney transplants: an old neglected surgical approach

“…Performance of this technique depends upon the vena cava being left intact and attached to the right renal vein when the organs are separated (1,9,11,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Multiple right renal veins can also be elongated with the inferior vena cava.…”

“…Despite, that this technique of the elongation of the right renal vein with the vena cava has been cited in literature for 30 years, even today it is neglected, which may jeopardize the viability of the kidney donated and the life quality of the recipient, as mentioned by others (1,5,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). As also recommended by the U.S.…”