Transplantation of a horseshoe kidney from a living donor using stapler for transsection

Abstract

Although it rather became a routine procedure to evaluate and use a cadaveric horseshoe kidney, using one from a living donor is quite rare. In this paper, we present methods we used during such a case which may benefit the procedures in the future. A 29-year-old female patient was considered for transplant and only viable living donor was her 59-year-old mother. Dynamic computed tomography revealed horseshoe anomaly with one renal artery and one renal vein for each side, a long but thin isthmus connecting lower poles with no visible arterial supply. Descending urography showed no connecting caliceal system. Donor nephrectomy was performed and isthmus separation was carried out with vascular stapler. Recipient was discharged on the 6th day with no complications. Patient was followed up for 6 months with normal creatinine levels. When properly assessed before the surgery, using a horseshoe kidney is not so challenging as thought.

En Bloc Transplantation of Horseshoe Kidney from Deceased Donor: An Unusual Transplantation Utilizing Kidneys with Congenital Fusion Abnormality

“…The number of published cases are few due to the rarity of this congenital defect and the difficulty of the surgery [ 1 , 2 , 6 , 7 ]. The first transplantation of horseshoe kidney was performed by Politano in 1963 and Nelson was the first to describe the technical aspects in 1975 [ 2 , 8 ].…”

“…Transplantation of horseshoe kidney is challenging due to the complexity of the vascular supply and anomalous collecting system [ 6 ]. These kidneys can be transplanted either en bloc or can be transplanted separately to two different recipients after isthmusectomy provided they have suitable anatomy of the vascular and collecting systems [ 7 ]. We opted to transplant en bloc as isthmusectomy could have resulted in ischemic injury to the lower pole of at least one kidney due to its shared vascularity.…”

“…In deceased donors, the transection of the isthmus, if considered, should be done in the back table [ 10 ]. Few cases of living donor heminephrectomy from a donor with horseshoe kidney after transecting the isthmus have been described [ 7 ].…”

Horseshoe kidney splitting technique for transplantation

“…Running sutures in one or more layers is the most common technique proposed in the literature 2 ; however, excessive tightening could tear the renal parenchyma apart. Other devices, such as a stapler 3 or a harmonic scalpel, 4 have also been used for this purpose.…”

Laparoscopic Living-Donor Nephrectomy of a Horseshoe Kidney: A Case Report and Review of the Literature

“…Due to all of this, concern for safety and feasibility of a living donor HSK has been questioned. However, according to the literature, since 1998, ten cases of successful HSK transplantation from live donors have been published (9 out of 10 from countries where deceased donation is not available) [1,11]. Outcomes are comparable with standard non-HSK donation with the most common complication reported being urinary leaks, likely due to the anterior situation of the urinary pelvis and the transected renal parenchyma [2,4,5,11].…”