Alternative Grafting Technique for Patients Unsuited to Heterotopic Transplantation due to Diseased Pelvic Conditions

Abstract

Introduction: An alternative technique for kidney transplantation is presented for patients in whom the use of pelvic vessels is precluded. Patients and Methods: Of 482 cases of kidney or pancreas-kidney transplants, 4 were unsuited to heterotopic grafting, 1 due to multiple operations in the fossae and the 3 others due to extensive vascular occlusive disease. The patients were studied preoperatively by magnetic resonance angiography, which revealed extensive occlusive disease of the distal aorta and/or iliac vessels. Results: The patients received kidneys from living related donors as a third or second transplant opportunity in the orthotopic position (2 cases). Gross dissection of the aorta revealed a thickened wall, impeding direct anastomoses between the recipient’s arteries and the donated organ. After a termino-lateral Dacron graft to the aorta, all cases were stented for uretero-uretero anastomosis. Recovery with respect to the renal graft was uneventful for all cases. Conclusions: Alternative direct grafting from the aorta represents a viable and easy way to perform kidney transplants in patients unsuited to the heterotopic approach.

Kidney Autotransplantation and Orthotopic Kidney Transplantation: Two Different Approaches for Complex Cases

“…Our work has revealed that at 12 months, the survival rate was 84.9%. These data are similar to those reported by Musquera et al and Hevia et al [ 2 ] According to the previously reported series by Paduch et al [ 10 ] and Rodrigues et al [ 11 ], graft rates of 100% during follow-up have been informed.…”

“…Our work has revealed that at 12 months, the survival rate was 84.9%. ese data are similar to those reported by Musquera et al and Hevia et al[2] According to the previously reported series by Paduch et al[10] and Rodrigues et al[11], graft rates of 100% during follow-up have been informed.According to Ruiz et al, after a mean follow-up of 73.1 months (range 7-312), 80% of the patients who underwent KAT have a functioning graft…”

Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

“…Open surgery for orthotopic kidney transplant has been reported in the literature as an effective alternative for those recipients in whom a heterotopic transplant was inappropriate, such as patients with a retained iliac fossa from a former graft, thrombosis of the iliac vein, or severe arthromatosis on the iliac artery. [15][16][17][18] The long-term patient and graft survival rates are comparable with those for conventional heterotopic kidney transplant. 18 However, open orthotopic kidney transplant has not been the favored approach because it is more difficult when compared with conventional heterotopic kidney transplant.…”

Orthotopic kidney transplantation survival and complications: systematic review and meta-analysis

“…In addition, two papers described people older than 60 years with multiple comorbidities and severe aortoiliac atherosclerosis [ 23 , 24 ]. Rodrigues et al described four cases (two young people and two older than 60 years old) with severe atherosclerosis [ 25 ]. Furthermore, Chan et al showed three patients (two young and one older than 60 years old) with inferior vena cava (IVC) thrombosis or stenosis [ 26 ].…”