Successful ex vivo renal artery reconstruction and renal autotransplantation

Abstract

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.

A Nationwide Analysis of Kidney Autotransplantation

“…A number of ureter pathologies such as tuberculosis, fibrosis, trauma, and tumors have been reported to result in extensive ureteral loss which may benefit from kidney autotransplant with restoration of continuity of ureter to bladder when simpler reconstruction methods are not possible. 7,23,24 Our results show kidney autotransplant for these patients has the lowest postoperative morbidity rate among indications of kidney autotransplantation. This is in line with previously reported excellent results for kidney autotransplantation for patients who require ureteral replacement.…”

The Use Ex-Vivo Renal Autotransplantation to Treat Hypertension Secondary to Renal Artery Disease: Two Case Reports

“…Two years after their respective surgeries, we assessed both patients via telephone contact by asking a set of closed questions, prepared by simplifying several questionnaires in the literature shown in table 2 [2][3][4]8,9]. The questionnaire was also designed according to the criteria defined by de Góes GM, et al [9].…”

“…However, the use of PCA may be ineffective or even harmful in patients with extensive renal artery involvement. This is more commonly seen in patients with Takayasu's arteritis, dysplastic myofiber lesions and those with multiple vessel involvement [3]. Several studies have sought to determine the extent of vascular injury required to illicit hypertension, requiring subsequent invasive treatment.…”

“…They have further demonstrated the absence of the hyperactivation reaction of the renin-angiotensin system in cases with arterial luminal stenosis exceeding 80%. Furthermore, the execution of luminal dilating procedures of the renal arteries has shown to be relatively ineffective [2][3][4][5][6][7][8][9][10]. RAT offers an effective alternative for those patients with multiple arterial lesions and clinical blood pressure control failure.…”

Assessment of Restored Kidney Transplantation Including the Use of Wider Criteria for Accepting Renal Donors After Cancer Excision

“…12 The use of the surgical techniques for RKT could also be used for auto renal transplantation thus conserving the normal remnant nephron mass. 19,20 Both restored kidneys and extended criteria donor kidneys may be considered to be suboptimal but their relative efficacy requires another adequately powered study.…”