Horseshoe kidney transplantation

Abstract

Abstract:Horseshoe kidney is a fusion anomaly found in approximately one in 400-600 people. Due to vascular and ureteral variations, transplantation with a horseshoe kidney presents a technical challenge. In our case, the isthmus connected the upper poles and contained parenchyma. It consisted of three renal arteries, fi ve veins collected to the inferior vena cava, and two ureters and pyelons. It was implanted en bloc to the left side retroperitoneally. During the early period, cellular and humoral rejection was confi rmed and treated. For a urine leak, double J catheters were implanted into both ureters. Later, the fi rst catheter was removed. Subsequently, urinary sepsis developed, necessitating graftectomy. The uncommon anatomy of ureters and antibody-mediated rejection (AMR) may both be factors for a ureter tip necrosis led to an infected urinoma. After other Hungarian authors, we also report a horseshoe kidney transplantation that was technically successful. However, after an adequately treated but severe acute humoral rejection, the patient developed sepsis, and the kidney had to be removed. We conclude that transplantation with horseshoe kidney is technically feasible but may increase the risk for urinary complications and resultant infections. Careful consideration of risk and benefi t is advised when a transplant professional is faced with this option.

Successful en bloc transplantation of a horseshoe kidney without division of the isthmus: first case reported in South Africa

“…Division of a thick isthmus increases the risk of bleeding and urinary leak. 6 A higher incidence of vesico-ureteric reflux (VUR), pelviureteric junction (PUJ) obstruction and ureteric duplication has been found in horseshoe kidneys and may predispose to urinary tract infections and urolithiasis. 2 The presence of these abnormalities should be identified prior to transplantation of horseshoe kidneys as it may affect the quality of the graft.…”

“…Despite the high incidence of complex vascular anomalies, the incidence of postoperative vascular thrombosis does not seem to be higher than in transplantation involving normal kidneys. 6 Though there is no data available from large series, reports indicate that the long-term outcomes for horseshoe kidney transplantation are similar to those of anatomically normal kidneys, provided that careful attention is paid to the unique anatomy of each case. 7 This case confirms that transplantation of horseshoe kidneys can be safely undertaken in the South African transplant environment.…”

Maximizing Nephron Mass in Horseshoe Kidney Transplantation Using Inferior Epigastric Artery: Case Report

“…The position, as well as the numbers of renal arteries and veins, varies greatly, while the renal isthmus often has a separate blood supply [5].…”

Graftectomiák a debreceni vesetranszplantációs programban

“…Egy betegünknél donorpatkóvesével végzett vesetranszplantáció technikailag sikeres volt ugyan, de ké-sőbb, feltehetően az egyik beültetett donorureter végé-nek (úgynevezett tip) nekrózisa talaján varratelégtelenség, vizeletcsorgás és progrediáló szepszis alakult ki, amely végül a graft eltávolítását tette szükségessé [17].…”