Transplantation of Horseshoe Kidney from Living, Genetically Unrelated Donor

Abstract

We report a case of renal transplantation using a horseshoe kidney from a living, genetically unrelated donor. The recipient was a 60-year-old man with diabetic nephropathy, and the donor was the 63-year-old wife of the recipient with a horseshoe kidney free of complications. Computed tomography showed two renal arteries and one renal vein on the left side, and the isthmus was perfused by several accessory arteries and veins. To demarcate the boundary of the isthmus, the left renal artery was ligated and cannulated for in situ perfusion. Furthermore, the isthmus was clamped, and the boundary of the isthmus was confirmed. The kidney was divided at the left margin of the perfused boundary. The cut ends of the isthmus were closed by sutures. The left kidney was transplanted into the right iliac fossa of the recipient. Asymptomatic fluid collection occurred on the cut surface at the isthmus of the donor, and this fluid decreased in due course. On the other hand, the recipient experienced no surgical complication or rejection, while maintaining serum creatinine levels of 2.00–2.20 mg/dL over a 22-month follow-up period. Horseshoe kidneys may be used for transplantation in selected cases after a detailed preoperative evaluation.

En Bloc Transplantation of Horseshoe Kidney from Deceased Donor: An Unusual Transplantation Utilizing Kidneys with Congenital Fusion Abnormality

“…In 15%, the fleshy isthmus can be replaced by fibrous tissue [ 2 ]. Since this fusion occurs before the medial rotation of the kidneys, the ureters can be found to lie anteriorly [ 3 ]. Normal vascular anatomy comprising of a single renal artery supplying each kidney is seen in just 30% cases [ 4 ].…”

“…We opted to transplant en bloc as isthmusectomy could have resulted in ischemic injury to the lower pole of at least one kidney due to its shared vascularity. There have been reports of the development of ischemia and urinary leak in the transplanted kidneys after isthmusectomy [ 2 , 3 , 9 ]. As a result, division of the horseshoe kidney can result in rendering one of the kidneys nonusable due to these injuries.…”

Laparoscopic Living-Donor Nephrectomy of a Horseshoe Kidney: A Case Report and Review of the Literature

“…A horseshoe kidney (HSK) is the most frequent renal fusion anomaly (1 in 400 to 800) [1][2][3][4][5][6][7][8][9][10] that involves abnormal migration of both kidneys with concomitant polar fusion. In over 90% of the cases this fusion occurs at the lower poles and as a result, two separate excretory renal units are maintained.…”

“…Because of this early fusion the kidneys fail to rotate medially during embryogenesis resulting in a ventral position of the renal pelvis with the ureters coursing in front of the lower poles. This may lead to abnormalities in the collecting system, therefore: urinary tract infections, vesicoureteral reflux, recurrent kidney stones and hydronephrosis, may frequently be observed [2,[5][6][7]. Variation in the origin, number and size of the renal arteries and veins is well known and described as well, with only 30% of all HSK having a single renal artery on each side [5,[7][8][9].…”

“…This may lead to abnormalities in the collecting system, therefore: urinary tract infections, vesicoureteral reflux, recurrent kidney stones and hydronephrosis, may frequently be observed [2,[5][6][7]. Variation in the origin, number and size of the renal arteries and veins is well known and described as well, with only 30% of all HSK having a single renal artery on each side [5,[7][8][9].…”