Our experience with third renal transplantation: Results, surgical techniques and complications

Abstract

Background: Despite the popularity of kidney transplantation in the current era, second and third kidney transplantation are not yet widely accepted and practiced. Each center has its own regulations and experiences and there is no accepted protocol for third kidney transplantation. We report here our 15 years of experience with third kidney transplantation. Methods: This is a report of all the third kidney transplantations performed in Baqiyatallah Hospital, Tehran, Iran, between 1991 and 2006. Demographic data, surgical techniques, complications and outcomes are reported. Results: Of the nine third kidney transplant patients, six were male. The median age was 43 years (32-52). All of the patients received kidney from living donors. All operations were performed by a midline incision and the grafts were placed at the midline, in the intraperitoneal space. For arterial anastomosis, we used internal iliac, right common iliac and both the right external iliac and inferior mesenteric artery in 4, 4 and 1 case(s), respectively. For venous anastomosis, we used vena cava, common iliac and external iliac veins in 3, 5 and 1 case(s), respectively. During the follow up period (38 months), 6 grafts (66.6%) were functioning. None of the graft rejections were due to surgical complications. Wound dehiscence occurred in two patients. No other surgical complications including infection, lymphocele or hemorrhage were observed. Conclusion: Third kidney transplantation is a field that has not been fully explored. The rate of complications seems to be not much higher than the first transplantation. Defining a standard protocol seems necessary.

Kidney Retransplantation in the Ipsilateral Iliac Fossa: A Surgical Challenge

“…Several retransplantation techniques have been described including the transperitoneal, retroperitoneal, and orthotopic approach (3)(4)(5)(6). This raises the question which technique has to be preferred.…”

Kidney retransplantation from HLA‐incompatible living donors: A single‐center study of 3rd/4th transplants

“…All transplants were performed via the extraperitoneal approach which can be particularly challenging due to extensive scarring from previous surgery. Other approaches such as transperitoneal and orthotopic transplantation have been described to avoid this problem although we have not found it necessary to use these in our practice so far . The use of standardized pre‐operative vascular imaging may have contributed to this—in many cases, severe iliac disease was identified that became important in the subsequent planning of operative strategy.…”

“…Significant fibrosis and scarring may hamper identification of correct tissue planes necessitating more complex vascular surgery and risking inadvertent collateral damage and complications. Anastomotic and overall operative times may be extended and have been associated with a detrimental impact upon morbidity …”

Repeat Kidney Transplantation

“…К недостаткам такого варианта можно отнести не-сколько больший риск сосудистых осложнений, так как в этой позиции трансплантат более моби-лен и его смещение или ротация может приводить к компрометации кровотока. Кроме того, послеопе-рационный период может осложниться кишечной непроходимостью, а при развитии мочевого затека или инфекционных осложнений в патологический процесс будет вовлечена брюшная полость [69,70].…”

“…По данным разных центров, частота хирургических осложнений варьирует от 0 до 37%. Также многие авторы сообщают о боль-шей кровопотере и продолжительности повторных трансплантаций почки [68][69][70][71][72].…”