Maximizing the donor pool: use of right kidneys and kidneys with multiple arteries for live donor transplantation

Keller, Jennifer; Dolce, Charles J.; Griffin, Daniel; Heniford, B. Todd; Kercher, Kent W.

doi:10.1007/s00464-009-0330-9

Cited by 40 publications

(29 citation statements)

References 20 publications

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“…No significant difference in estimated blood loss, transfusions, operative time or length of hospital stay was noted between multiple and single laparoscopic donor nephrectomies. 4 Benedetti et al reported the same results among 163 patients with MRA versus 835 with single renal arteries. 5 Available studies support that donor morbidity and recipient intraoperative, early and late postoperative outcomes do not differ between donors with multiple renal arteries and those with a single renal artery.…”

supporting

confidence: 65%

“…Although symmetrical peripheral oedema is well documented with the use of sirolimus, there are limited reports of single limb lymphoedema. [1][2][3][4] A 59 year old woman with a stable renal allograft for 17 years, presented with extensive and debilitating unilateral swelling of the entire left arm following a suspected insect bite 2 weeks before presentation. She had a functioning radiocephalic fistula in the affected arm.…”

Section: Matthew J Damasiewicz and Francesco L Ierino Department Of mentioning

confidence: 99%

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A Candidate Kidney Donor With Anatomic Variations in Renal Arteries

Stoumpos¹,

Galinas²,

Karathanasis³

et al. 2010

Nephrology

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Additional Supporting Information may be found in the online version of this article:Figs S1 and S2. Contrast enhanced computed tomography of the thorax demonstrates oval-shaped paravertebral soft tissue tumours on the course of several intervertebral nerves. Figs S3 and S4. Pre-(3) and postcontrast (4) T1-weighted images show a faint enhancement of the paravertebral masses.A 53 year old man was admitted to the hospital for a preoperative assessment as a candidate donor of a renal graft. His medical history included coronary artery disease, which was treated with balloon angioplasty and the placement of an intraluminal coronary artery stent in the left anterior descending artery 1 year before his admission. Digital subtraction angiography (DSA) of the renal arteries manifested the presence of four renal arteries in the left kidney ( Fig. 1) and the coexistence of a main and a polar artery in the right kidney. The right polar artery supplied a segment of the lower pole of the right kidney and stemmed from a common branch with the ipsilateral inferior phrenic artery.The high frequency of polar arteries, multiple arteries and the origin of renal arteries from the aorta at different heights or from other arteries can be explained by the embryological development of the kidney. The occurrence of four renal arteries is of a rare incidence (<1%) 1 while a lower polar artery correlates with an increased rate of recipient ureteral complications. 2 Polar arteries and multiple renal arteries are important in kidney transplantation. Multiple renal arteries (MRA) are the most frequently encountered anatomical variation in kidneys. In one report the incidence of unilateral MRA was 23%, and that of bilateral MRA was 10%. 3 Keller JE et al. reviewed a total of 230 laparoscopic donor nephrectomies performed at a single institution. Multiple arteries were present in 37 donors. No significant difference in estimated blood loss, transfusions, operative time or length of hospital stay was noted between multiple and single laparoscopic donor nephrectomies. 4 Benedetti et al. reported the same results among 163 patients with MRA versus 835 with single renal arteries. 5 Available studies support that donor morbidity and recipient intraoperative, early and late postoperative outcomes do not differ between donors with multiple renal arteries and those with a single renal artery.The gold standard technique for preoperative donor evaluation is a DSA as it provides a precise evaluation of supernumerary and accessory renal vessels. However, the procedure is invasive, uses ionizing radiation and large amounts of nephrotoxic opaque material. Additionally, selective catheter placement in the renal arteries comprises an increased risk for intimal injury, dissection and subsequent stenosis of the vessel. 6 Magnetic resonance angiography (MRA) is an acceptable alternative non-invasive imaging modality in donors because it has the added benefits of no iodinated contrast material and no exposure to ionizing radiation. MRA is inadequate in detecting s...

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supporting

confidence: 65%

Section: Matthew J Damasiewicz and Francesco L Ierino Department Of mentioning

confidence: 99%

A Candidate Kidney Donor With Anatomic Variations in Renal Arteries

Stoumpos¹,

Galinas²,

Karathanasis³

et al. 2010

Nephrology

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“…We believe that technical concerns, particularly related to the short renal vein, in conjunction with increasing familiarity with the laparoscopic technique leading to a comfort level in the use of left-sided kidneys with multiple renal arteries, explain the continued preference for left-sided kidney use (2,12,21). Interestingly, the declining proportion of right-sided kidneys has taken place despite a series of studies reporting similar outcomes between right and left kidneys recovered using LDN.…”

Section: Discussionmentioning

confidence: 87%

Increased Early Graft Failure in Right-Sided Living Donor Nephrectomy

et al. 2011

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“…Liu et al reported similar surgical outcomes in 19 left-sided HALDNs and 6 right-sided HALDNs [9]. Keller et al reported that 36 right-sided procedures out of 230 LDNs showed similar results in EBL, amount of blood transfusion, operative time, LOS, and delayed graft function compared with left-sided HALDN [20]. There have been more reports about the excellent surgical outcomes of right laparoscopic donor nephrectomy compared with left-sided operations [21-23].…”

Section: Discussionmentioning

confidence: 99%

Hand-Assisted Laparoscopic Right Donor Nephrectomy: Safety and Feasibility

et al. 2010

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PurposeWe aimed to prove the safety and feasibility of right-sided hand-assisted laparoscopic donor nephrectomy (HALDN).Materials and MethodsBetween May 2006 and May 2009, 16 patients underwent right-sided HALDN at our institution. Of these patients, 15 showed significantly lower renal function in the right kidney than in the left one and 1 had a stone in the right kidney. When the right renal vein was divided, an EndoGIA stapling device was placed on the wall of the inferior vena cava to gain a maximal length of the vein. We evaluated intraoperative and postoperative parameters such as operative time, delivery time, warm ischemic time, estimated blood loss, intraoperative and postoperative complication rates, length of hospital stay, and serum creatinine levels of donors (at the time of discharge) and recipients (4 weeks postoperatively), comparing the right-sided HALDN group (our study) with a left-sided HALDN group (from a previously reported study).ResultsA total of 16 right-sided HALDNs were successfully performed without any complications or open conversion. All of the intraoperative and postoperative parameters were similar between the right-sided HALDN and left-sided HALDN groups. There were no technical problems in the recipients in the anastomosis of the renal vein, and the ureteral anastomoses were also successful.ConclusionsRight-sided HALDN is safe and technically feasible in a donor, showing favorable graft outcomes. The results of our study suggest that right-sided HALDN may be preferable in patients with significantly lower renal function in the right kidney than in the left one.

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Maximizing the donor pool: use of right kidneys and kidneys with multiple arteries for live donor transplantation

Cited by 40 publications

References 20 publications

A Candidate Kidney Donor With Anatomic Variations in Renal Arteries

A Candidate Kidney Donor With Anatomic Variations in Renal Arteries

Increased Early Graft Failure in Right-Sided Living Donor Nephrectomy

Hand-Assisted Laparoscopic Right Donor Nephrectomy: Safety and Feasibility

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