Donor gonadal vein reconstruction for extension of the transected renal vessels in living renal transplantation

Abstract

Introduction:Donor gonadal vein is a readily available vascular reconstruction material for vascular reconstruction, for difficult situations, in living related renal transplantation. Vein extension with the gonadal vein has been described as a simple and safe method to elongate renal vein especially in right living donor kidneys. We applied the donor gonadal vein for lacerated accessory renal artery and renal vein reconstruction.Materials and Methods:The donor gonadal vein was used to reconstruct the lacerated accessory renal artery in one patient. The donor gonadal vein was isolated, used as an interposition graft to bridge the gap between transected accessory renal artery and external iliac artery of the recipient. In another patient, gonadal vein was used to reconstruct short right renal vein, which got damaged during retrieval.Results:This technique resulted in a tension-free anastomosis. There were no procedure related complications. The ischemia time remained within acceptable limits and grafts showed excellent outcomes.Conclusions:The use of gonadal vein for renal vascular reconstruction seems to be an acceptable option during living related renal transplantation, lest the need arise, with no increased graft morbidity.

Renal Vein Lengthening Using Gonadal Vein Reduces Surgical Difficulty in Living‐Donor Kidney Transplantation

“…Similarly, Troncoso et al [14] described renal vein extension with the gonadal vein as a useful strategy for employing right living‐donor kidneys. The recognized advantages are tension‐free anastomosis, an acceptable warm ischemia time, and a lack of complications and graft morbidity [10]. In our experience and that of other researchers [5, 7, 10–12], lengthening of the renal vein of the right donor kidney significantly decreases the surgical difficulty of transplantation, relatively shortens the time for transplantation, and reduces the warm ischemia time of kidney transplantation.…”

“…The problem of a short renal vein can be resolved by lengthening it with suitable grafts and technique. This has been done by hand‐assisted cavotomy [4], by the modified Endo GIA stapler approach [6, 9], and by application of various veins, such as the gonadal vein [10], superficial femoral vein [5], and inferior vena cava [11]. However, because various veins have different diameters, it can be difficult to find a suitably matched vein for effective renal vein lengthening.…”

“…The gonadal vein is especially suitable because it is essentially useless and can be easily accessed and ligated during donor nephrectomy. Its diameter is ideal for accomplishing renal vein and arterial reconstruction [10], making the gonadal vein especially appropriate to use for renal vein lengthening without producing any additional injury.…”

Laparoendoscopic single-site donor nephrectomy

“…In one of our cases of right LESS-DN, we encountered a renal vein tear apparently during graft retrieval;[ 16 ] this required reconstruction of the renal vein with a segment of the gonadal vein. In one case with a reteroaortic vein, we encountered a large-bowel injury which required exploratory laparotomy, the injury was sustained during refection of the colon.…”