Orthotopic Kidney Transplant: a Valid Surgical Alternative for Complex Patients

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• 作者：Vital Hevia (1)
  Victoria Gómez (1)
  Sara álvarez (1)
  Víctor Díez-Nicolás (1)
  Ana Fernández (2)
  Francisco Javier Burgos (1)
  
• 关键词：Orthotopic kidney transplant ; Renal transplant ; Complex receptor ; End ; stage renal disease
• 刊名：Current Urology Reports
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：16
• 期：1
• 全文大小：442 KB
• 参考文献：1. Gil-Vernet JM. New approach to the splenic vessels. J Urol. 1978;119:313-.
  2. Gil-Vernet JM. Orthotopic renal transplant and results in 139 consecutive cases. J Urol. 1989;142:248-2.
  3. Musquera M. Orthotopic kidney transplantation: an alternative surgical technique in selected patients. Eur Urol. 2010;58:927-3. / It’s the most important article regarding OKT in literature with 223 cases. CrossRef
  4. Ferri M. Orthotopic renal transplantation in a patient with a massive pelvic arteriovenous malformation. J Urol. 2000;163:899. CrossRef
  5. Paduch DA. Indication, surgical technique and outcome of orthotopic renal transplantation. J Urol. 2001;166:1647-0. CrossRef
  6. De Gracia R. Orthotopic renal transplant: our experience. Actas Urol Esp. 2007;31(10):1123-. CrossRef
  7. Rizello A. Successful splenic venous drainage for kidney transplant in case of inferior vena cava thrombosis. Transplantation. 2011;92(10):59-0. CrossRef
  8. Aguirrezabalaga J. Superior mesenteric venous drainage for kidney transplantation in patients with inferior vena cava thrombosis: presentation of two cases. Transplant Proc. 2002;34:410-. CrossRef
  9. Izquierdo L. Third and fourth kidney transplant: still a reasonable option. Transplant Proc. 2010;42:2498-02. / Paper about thirds and fourths kidney transplants and the results, including some OKTs. CrossRef
  10. Blanco M. Third kidney transplantation: a permanent medical-surgical challenge. Transplant Proc. 2009;41:2366-. CrossRef
  
• 作者单位：Vital Hevia (1)
  Victoria Gómez (1)
  Sara álvarez (1)
  Víctor Díez-Nicolás (1)
  Ana Fernández (2)
  Francisco Javier Burgos (1)
  
  1. Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
  2. Nephrology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
  
• ISSN：1534-6285

文摘

Kidney transplant is the best alternative of treatment for patients with end-stage renal disease (ESRD). At present, a significant part of patients admitted to waiting list are older and have previous transplants or severe vascular atheromatosis. In these cases, orthotopic kidney transplant (OKT) could be an option. The aim of the study is to present our results with this technique in terms of surgical steps, complications, and outcomes. Between January 1977 and August 2014, 1549 kidney transplants were performed in our transplant unit. Nine of them were OKT and were performed according to principles described by Gil-Vernet. All data were reviewed retrospectively. Nine OKTs were performed in seven males and two females, with a mean age of 49.3?years (range 24-7). Donor mean age was 40.5 (18.5-2.5) and the follow-up mean time was of 91.8?months (8-26). Seven cases were first transplants and two were third transplants, all of them from deceased donors. Indication for the OKT was an unsuitable iliac region in six (66.6?%) and abnormalities in the low urinary tract or urinary diversions in three (33.3?%). Delayed graft function (DGF) was present in 22.2?% (2/9). Three patients (33.3?%) developed early surgical complications: one bleeding (Clavien IIIb), one arterial thrombosis (IIIb), and one pancreatic leak (IIIb). Two patients (25?%) had late complications: one ureteral stricture (IIIb) and one reflux nephropathy (IIIa). Mean serum creatinine after OKT was 1.7, 1.5, and 1.8?mg/dl at 1?month, 1?year, and 5?years, respectively. Mean graft survival was 80.7?months (range 0-26). At present, three patients are alive with functioning graft, three patients died with functioning graft, two patients returned to dialysis many years after the transplant, and one lost the graft due to an arterial thrombosis in the early postoperative course. OKT is a valid option for patients with unsuitable iliac regions such as those with third transplants, severe atheromatosis, or vena cava thrombosis. It is also an option for those patients with urinary diversions. Functional results are good, although it is a technique not exempted from complications. Two thirds of the patients have a long-term survival of the graft, and a third of the patients die with functioning graft.