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.

Complex Vascular Reconstruction of an En Bloc Pediatric Kidney Damaged during Organ Procurement

“…In order to reduce the risk of these vascular complications, we describe the use of cap-shaped patches from the same donor as a conduit in both proximal ends of the allograft aorta and IVC and at the distal allograft vascular end, providing increased length to reduce excessive traction and subsequent thrombosis and/or stenosis [ 16 , 17 ]. The use of elongation patches and conduits proves to be a useful and safe method for decreasing the incidence of vascular-related complications in transplantation [ 3 ].…”

Transplantation of 2-Month-Old En Bloc Pediatric Kidneys After a Complex Vascular Reconstruction – Traveling 2500 Miles to Get Transplanted: A Case Report

“…Therefore, aiming to avoid vascular complications secondary to excessive traction at the anastomotic sites, in our patient, cap-shaped same-donor grafts were placed in both proximal ends of the allograft aorta and IVC [ 23 ], and 2 conduits were placed at the distal allograft vascular ends, thus permitting their elongation. The reconstruction using vascular elongation patches and conduits has proved to be a useful and safe method for decreasing the incidence of vascular-related complications in transplantation [ 7 , 24 ].…”

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“…The anastomosis between the iliac vein of the receptor and a (short) transplant renal vein may lead to a series of technical problems (eg, angulation or tension of the venous anastomosis, 7 reduced mobility, limited placement, and inspection of the graft for hemostasis). [8][9] These problems may lead to venous hemorrhage or thrombosis. 10 And renal vein thrombosis is a serious complication that can lead to graft nephrectomy, despite medical or surgical therapy.…”