Renal Autotransplantation: An Alternative to Standard Renal Revascularization Procedures

Sicard, Gregorio A.; Valentin, Leonardo I.; Freeman, Michael B.; Allen, Bradley S.; Anderson, Charles B.

doi:10.1016/s0022-5347(17)40970-0

Cited by 6 publications

(9 citation statements)

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“…This is consistent with outcomes reported by Belzer and Raczkowski, who showed that 86% of patients were normotensive or on minimal antihypertensive medication after 10 years of follow up 4 . Later studies have described equivalent or better results: significant improvements or cure of hypertension in 97% of cases; 6,11 a significant reduction in serum creatinine; 7 stable renal artery reconstructions demonstrated on follow up angiograms; and successful aneurysm repair in 92% of cases 6 …”

Section: Discussionsupporting

confidence: 86%

“…There are numerous indications for ex vivo surgery and autotransplantation. In atherosclerotic occlusive disease and FMD these are: unilateral stenotic disease in a single kidney or bilateral disease requiring repair; previous failed in situ repair or percutaneous transluminal renal angioplasty (PTRA); extensive aortic atheroma with poor quality wall; reconstructions where the projected ischaemic time is anticipated to be > 45 min; renal artery stenosis in children; renal artery branch aneurysms; and renal artery dissection, FMH or occlusive atheromatous disease extending into the branch arteries 4,7,12 . Other indications include vascular trauma; arteriovenous fistulas or malformations of branch arteries; 1 midaortic syndrome with renal artery occlusive disease or ostial stenosis; 9,19 and the loin pain–haematuria syndrome 10,20,21 …”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, the techniques developed from work on cadaveric and living related renal transplantation stimulated further development of ex vivo renal artery surgery and autotransplantation 3,4 . Hence, ex vivo RAR and autotransplantation now have an important role in the treatment of a variety of vascular, urologic and other diseases 5–10 …”

Section: Introductionmentioning

confidence: 99%

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Successful ex vivo renal artery reconstruction and renal autotransplantation

Cho¹,

Robinson²,

Grant³

et al. 2001

ANZ Journal of Surgery

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Background: The increasing experience with renal allotransplantation has led to continuing development in vascular surgical techniques. These improvements have enabled complex ex vivo renal artery surgery and renal autotransplantation to be performed. The aims of the present study were to describe the results achieved with renal autotransplantation and ex vivo renal artery reconstruction (RAR) at the Newcastle Transplant Unit, John Hunter Hospital, and to review the current indications for such surgery. Methods: A retrospective review was performed of patients who required renal autotransplantation with or without RAR at John Hunter Hospital, between 1991 and 1999. Data were obtained from the Newcastle Transplant Unit and the Medical Record Department of John Hunter Hospital. Results: Two patients required ex vivo RAR and renal autotransplantation for severe fibromuscular dysplasia (FMD) complicated by stenoses and renal artery branch aneurysms. The third patient required autotransplantation for bilateral retroperitoneal fibrosis. There was one postoperative complication of pelviureteric junction obstruction that was treated successfully with a temporary ureteric stent. All patients demonstrated normal graft function and were normotensive on follow up, which ranged from 2.5 to 5 years. Conclusion: The present review confirms the long‐term benefits of ex vivo RAR and renal autotransplantation that have been demonstrated by previous studies. In transplant units experienced with this surgery it has been shown to be a successful and durable technique for the treatment of a variety of vascular, urologic and other diseases.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful ex vivo renal artery reconstruction and renal autotransplantation

Cho¹,

Robinson²,

Grant³

et al. 2001

ANZ Journal of Surgery

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“…These results are similar to others that report stable or improved renal function in 69 to 100% patients. [35,36] The overall mortality rate was 9% and complication included ventilator-associated pneumonia, subclavian vein thrombosis, and transient ileus in one patient each, all were treated successfully without any sequel. Previous series have reported a transient rise in liver enzyme, without any permanent or major problem with hepatic function following hepatorenal shunt.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of patients undergoing extra-anatomic renal bypass surgery for renovascular hypertension

2011

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Renal artery disease is the most common cause for surgically curable form of hypertension. In a small subset of patients with severe aortic disease where the aorta is not suitable for endovascular technique and to provide an arterial inflow, an extra-anatomic renal bypass surgery (EARBS) is an option. Anesthetic management of such procedures has not been described so far in the literature. We retrospectively analyzed the anesthetic techniques used in all patients who underwent EARBS between February 1998 and June 2008 at this institute. We also further analyzed data concerning blood pressure (BP) control and renal function response following surgery as outcome variable measures. A total of 11 patients underwent EARBS during this period. Five received oral clonidine with premedication. During laryngoscopy, esmolol was used in 4 patients, while lignocaine was used in remaining 7 patients. Of 11 patients, 7 showed significant hemodynamic response to laryngoscopy and intubation; among these, one had oral clonidine with premedicant, and 6 received lignocaine just before laryngoscopy. Intravenous vasodilators were used to maintain target BP within 20% of baseline during perioperative period. All patients received renal protective measures. During follow-up, 10% were considered cured, 70% had improved BP response, while 20% failed to show improvement in BP response. Renal functions improved in 54.5%, remain unchanged in 36.5%, and worsened in 9% of patients. Use of clonidine during premedication and esmolol before laryngoscopy were beneficial in attenuating hemodynamic response to laryngoscopy, while use of vasodilators to maintain target BP within 20% of baseline, and routine use of renal protective measures appear to be promising in patients undergoing EARBS.

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“…In certain situations, PTA may be ineffective or contraindicated, such as in aneurysmal lesions, lesions involving distal and intrahilar segmental renal artery branches, or inflammatory lesions such as those observed in Takayasu disease. 4,5 Fibromuscular disease involving the trunk of the renal artery with segmental dissection may be unsuitable for PTA. A series of 63 patients in such situations has been reported by Brekke and coworkers.…”

Section: Renovascular Diseasementioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Advances in transplantation led to the first renal autotransplant in 1963 performed due to high ureteral injury sustained during aortic surgery. The procedure involves excision of the kidney and autologous re-implantation. Subsequently, multiple cases of renal autotransplantation have been reported in the literature for a range of indications. This reviews aims to assess the literature and experiences reported to assess the varying indications for renal autotransplant.The evidence and literature generated from experiences in this procedure are largely limited to case reports and relatively small or moderately sized case series. The main indications reported for performing autotransplant broadly includes renovascular disease, ureteral pathology and neoplastic disease. The advent of laparoscopic techniques and their implications on renal autotransplant also are discussed. Varying degrees of success are reported with this procedure with controversial issues surrounding this procedure remain, particularly in the area of neoplastic surgery. Renal autotransplant may be a useful last resort in preventing kidney loss in highly selected circumstances and when conventional methods have failed.

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Renal Autotransplantation: An Alternative to Standard Renal Revascularization Procedures

Cited by 6 publications

References 0 publications

Successful ex vivo renal artery reconstruction and renal autotransplantation

Successful ex vivo renal artery reconstruction and renal autotransplantation

Anesthetic management of patients undergoing extra-anatomic renal bypass surgery for renovascular hypertension

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