Transplantation of a Horseshoe Kidney Found During Harvest Operation of a Cadaveric Donor: A Case Report

Abstract

A 34-yr-old female was diagnosed as being brain dead. Preoperative ultrasound revealed no abnormal focal lesions. However, the horseshoe kidney was identified during organ harvest. En bloc nephrectomy was performed. The kidney was divided at the midline of isthmus. The divided right kidney was discarded due to numerous arteries and veins. The divided left kidney was transplanted. After declamping, the kidney was well perfused and started clearing. Resistive index was 0.72. Glomerular filtration ratio was 84.69 mL/min on postoperative day 14. The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.Graphical Abstract

Kidney transplantation using split horseshoe kidney – a case report

“…Kod takvih anomalija redovito se ne uspijeva izvesti transplantacija en bloc, nego se poku šava pripremiti barem jedna polovica bubrega za tran splantaciju. 13 U krajnjim slučajevima cijeli bubreg može biti nepogodan za transplantaciju pa se mora odbaciti.…”

“…Time se olak šava spajanje rubova presječenih dijelova, što smanjuje mogućnost krvarenja i/ili nastajanja urinarne fistule. 13 Naime, opisan je bolesnik kod kojega je nakon podve zivanja manje arterije koja je opskrbljivala istmus došlo do poslijeoperacijske ishemije istmičnog područja i razvoja urinarne fistule što je nalagala operacijsko lije čenje. 19 Također se, kao što je učinjeno u našeg dariva telja, preporučuje injicirati metilensko plavilo u renal nu arteriju radi određivanja granice između dvaju dijelova bubrega.…”

“…19 Također se, kao što je učinjeno u našeg dariva telja, preporučuje injicirati metilensko plavilo u renal nu arteriju radi određivanja granice između dvaju dijelova bubrega. 13,20 U većini transplantacijskih centara, pa tako i u naše mu, nastoji se da pijelon bude najpovršnija struktura hilusa radi lakšeg pristupa ureteru ili pijelonu pri raz voju ureteralnih komplikacija i/ili komplikacija kanal nog sustava bubrega. Zbog toga je nužno bubreg okre nuti te se redovito desni bubreg transplantira u lijevu ilijakalnu jamu i obrnuto.…”

Diameters of Arteries Supplying Horseshoe Kidneys and the Level They Branch off Their Parental Vessels: A CT-Angiographic Study

“…For normal kidneys, the vascular system is a source of numerous complications during surgical procedures involving abdominal region, such as kidney transplantation, implantation of vessel stents, kidney stone surgery or aortic aneurysm management [6,7,8]. Although procedures involving horseshoe kidneys are not as well described, their importance is likely to increase as they are affected by similar diseases as typical kidneys [9,10,11,12].…”