Ureteral Papilla Implantation as a Technique for Neoureterocystostomy in Cats Undergoing Renal Transplantation: 30 Cases

Sutherland, Brian J.; McAnulty, Jonathan F.; Hardie, Robert J.

doi:10.1111/vsu.12476

Cited by 7 publications

(6 citation statements)

References 16 publications

(51 reference statements)

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“…The renal transplant procedure was performed as previously described by Sutherland et al 10 The left kidney was removed from the donor cat and immediately flushed with (~20 ml) of cold, buffered sucrose phosphate preservation solution. The kidney was stored in preservation solution (~4°C) for approximately 1–4 h prior to implantation.…”

Section: Resultsmentioning

confidence: 99%

Retroperitoneal fibrosis as a postoperative complication following renal transplantation in cats

Byer

Hardie

McAnulty

2021

Journal of Feline Medicine and Surgery

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Objectives The aim of this report was to describe the clinical signs, diagnostic imaging findings, surgical management, histopathological findings, outcome and possible risk factors for cats that developed retroperitoneal fibrosis (RPF) following renal transplantation. Methods Medical records of cats that underwent renal transplantation and developed clinically significant RPF between 1995 and 2019 were reviewed. Results Eighty-one cats underwent 83 renal transplantations. Of these 81 cats, six developed clinically significant RPF. For all six cats, renal transplantation was performed using cold organ preservation solution and ureteral papilla implantation. Immunosuppression protocol included ciclosporin and prednisolone. All cats had at least one subtherapeutic trough ciclosporin level (<250 ng/ml) in the postoperative period. Cats presented with moderate-to-severe azotemia 39–210 days following renal transplantation. Abdominal ultrasonography and contrast pyelography revealed various degrees of hydroureter and hydronephrosis of the transplanted kidney. Surgical examination revealed a layer of dense fibrous tissue surrounding the transplanted kidney, ureter and bladder resulting in ureteral obstruction. Ureteral obstruction was managed by reimplantation of the proximal ureter or renal pelvis to the bladder. Histopathologic examination of the fibrous tissue and affected portion of the distal ureter revealed fibrous connective tissue with lymphoplasmacytic infiltration and perivascular inflammation suggestive of an autoimmune type reaction. Of the six cats, two died within 5 days after revision surgery, two developed signs consistent with recurrent partial ureteral obstruction (40 and 41 days after revision), one was euthanized 6 years later for an unrelated disease and one was lost to follow-up. Conclusions and relevance The incidence of RPF in this population of cats was relatively low (7%), but still represents a significant cause of morbidity and mortality. The cause of RPF remains unknown, although investigation into suboptimal immunosuppression as a potential cause for local rejection reaction is warranted.

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Section: Resultsmentioning

confidence: 99%

Retroperitoneal fibrosis as a postoperative complication following renal transplantation in cats

Byer

Hardie

McAnulty

2021

Journal of Feline Medicine and Surgery

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“…[1][2][3] Despite progressive advances in the transplantation technique, technical complications remain an important cause of postoperative morbidity, with overall perioperative mortality ranging from 13% to 29%. [2][3][4] Vascular anastomosis-related complications are an important reason for perioperative morbidity and include hemorrhage, thrombosis, dehiscence, and hind limb neuropraxia. The very small diameter and fragile nature of the renal vessels in cats make vascular anastomosis technically challenging.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] Reports describing the use for arterial anastomosis are less common because of the thickness and muscularity of the arterial walls, which make eversion over the coupler pins challenging. 6,[4][5][6][7][8][9][10][11][12][13][14][15][16][17] To the best of our knowledge, use of a MAC for end-toside (ETS) vascular anastomosis has not been described in cats. The objective of this study was to describe the technique and determine the feasibility of using a MAC for ETS anastomosis of the renal vein to vena cava and renal artery to aorta for feline renal transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…The procedure has evolved over the past 25 years, with success reported in 70% to 90% of cats 1‐3 . Despite progressive advances in the transplantation technique, technical complications remain an important cause of postoperative morbidity, with overall perioperative mortality ranging from 13% to 29% 2‐4 . Vascular anastomosis‐related complications are an important reason for perioperative morbidity and include hemorrhage, thrombosis, dehiscence, and hind limb neuropraxia.…”

Section: Introductionmentioning

confidence: 99%

“…The device is most commonly used for venous anastomosis because of the increased pliability of veins and the ease of everting the vessel walls over the coupler pins 9‐11 . Reports describing the use for arterial anastomosis are less common because of the thickness and muscularity of the arterial walls, which make eversion over the coupler pins challenging 6,4‐17 …”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a microvascular anastomotic coupler for end‐to‐side arterial and venous anastomosis for feline renal transplantation

et al. 2020

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Objective: To describe the technique and determine the feasibility of an endto-side (ETS) anastomosis of the renal vein to vena cava and renal artery to aorta using a microvascular anastomotic coupler (MAC) for feline renal transplantation. Study design: In vivo experimental study. Animals: Six purpose-bred domestic shorthair cats. Methods: The left kidney was autotransplanted using a MAC for ETS vascular anastomosis. Outcomes included intraoperative hemorrhage from the anastomosis sites, duration of anastomoses, surgical complications, postoperative renal perfusion (including resistive index (RI)) measured by Doppler ultrasonography and computed tomography angiography, and histopathological examination of the left kidney and anastomosis sites (30 days). Results: Anastomosis was successful in all cats, and intraoperative hemorrhage was negligible. Intraoperative renal perfusion was considered excellent. Venous and arterial anastomoses were completed in 11 minutes 20 seconds (range, 6:38-13:27) and 21 minutes 50 seconds (range, 11:05-30:24), respectively. Vascular occlusion time was 32 minutes (17:43-42:03). One cat was euthanized 5 hours postoperatively because of bleeding from a muscular arterial branch of the dorsal aorta causing hemoabdomen. Renal perfusion and RI of the remaining five cats were within normal range (<0.8) and similar to the contralateral kidney at all time points. Endothelialization of the anastomosis was complete with mild-to-moderate fibrosis surrounding the MAC in all cats. Conclusion: End-to-side anastomosis of the renal vein and artery to the vena cava and aorta, respectively, was consistently achieved in all six cats with the MAC. Clinical significance: The use of the MAC may be considered as an alternative to hand suturing for ETS anastomoses for feline renal transplantation.

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Renal Transplant

Schmiedt¹

2023

Small Animal Soft Tissue Surgery

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Ureteral Papilla Implantation as a Technique for Neoureterocystostomy in Cats Undergoing Renal Transplantation: 30 Cases

Cited by 7 publications

References 16 publications

Retroperitoneal fibrosis as a postoperative complication following renal transplantation in cats

Retroperitoneal fibrosis as a postoperative complication following renal transplantation in cats

Evaluation of a microvascular anastomotic coupler for end‐to‐side arterial and venous anastomosis for feline renal transplantation

Renal Transplant

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