Retroperitoneoscopic Live Donor Nephrectomy in a Patient with a Double Inferior Vena Cava
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Abstract:
Vascular anomalies are considered a contraindication for laparoscopic live donor nephrectomy. We report a successful hand-assisted retroperitoneoscopic live donor nephrectomy from a donor with a double inferior vena cava.A 37-year-old woman wanted to donate a kidney to her 44-year-old boyfriend who had hypertensive nephropathy. Preoperative donor imaging showed a double inferior vena cava. Each renal vein drains into the ipsilateral inferior vena cava division, making the left renal vein short. A single renal artery, vein, and ureter were noted on both sides. A hand-assisted retroperitoneoscopic left nephrectomy was performed. Blood loss was minimal and the warm ischemia time was 2 minutes. Renal transplantation was performed with good initial perfusion and urine output. Cold ischemia and rewarming time was 25 minutes.The donor postoperative period was uneventful with infrequent need for pain relief. The donor was discharged in good condition 3 days postoperatively. The donor's kidney functions were within the normal range at follow-up 4 months postoperatively. The recipient was discharged in good condition 7 days postoperatively. The recipient is alive with good graft function and unremarkable complications at 4 month follow-up.Although vascular anomalies present a surgical challenge, we have shown the feasibility of performing hand-assisted retroperitoneoscopic live donor nephrectomy in a donor with a double vena cava and short renal vein. With comprehensive preoperative assessment, laparoscopic live donor nephrectomy can be done safely in donors with anatomical anomalies. This may increase the number of living donor kidney transplants as it offers lower postoperative morbidity and economic disincentives for potential donors.Keywords:
Renal vein
Contraindication
In all over the world, most serious concern about the organ transplantation is that the number of patients who are waiting for organ transplantation has increased however the number of a available organ is not enough. Because of this, the graft which previously considered contraindication for transplantation have been successfully transplanted due to development of technique, drug and improvement postoperative management of patients. Fibromuscular dysplasia (FMD) is the second most common cause of renovascular hypertension, and is observed in 2.0% to 6.6% of potential live kidney donors. Kidney with FMD is generally considered to be a contraindication to renal transplantation because renal artery stenosis may progress after transplantation and cause graft loss. However, Here, we report a successful case of kidney transplantation using graft with FMD which has multiple aneurysms in renal artery. in deceased donor.
Contraindication
Fibromuscular Dysplasia
Renovascular Hypertension
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The kidneys are a pair of retroperitoneal organs located at the level of the L1, L2, and L3 positions. At the level of the tenth rib, the superior portion of the kidney is located within the lower thoracic cage. Due to the existence of the liver, the right kidney is lower than the left kidney. The adult kidney weights about 150 gm. Right kidney is broad and short and left kidney is narrow and long. Right renal artery is longer than the left renal artery and right renal vein is shorter than the left renal vein. Renal arteries are end arteries while veins anastomose freely. Left gonadal vein and left suprarenal vein (adrenal vein) drain into the left renal vein. Right suprarenal vein and gonadal vein drain into inferior vena cava. Both the ureters are draining from the kidneys behind the renal artery. From anterior to posterior we get renal vein, renal artery and ureter. In this case report we found pair of kidney with renal vein and renal artery. Right renal artery is longer than the left renal artery and left renal vein is longer than the right renal vein. We can see the posterior aspect of inferior vena cava.Left gonadal vein and left suprarenal vein (adrenal vein) are draining into the left renal vein. Right suprarenal vein and gonadal vein are draining into inferior vena cava. Both the ureters are draining from lower end behind the renal artery. From anterior to posterior we get renal artery, renal vein and ureter. Here we are getting duplication of ureter in the left side. On right side, there three accessory renal arteries, one to the inferior pole and two to the hilum behind the main renal artery of the kidney. On the left side, there are two renal arteries one going to the hilum behind the main renal artery and one going to the inferior pole of the kidney. On right side ureter is draining behind the renal vein. The duplex ureter drains behind the renal vein on the left side. The left suprarenal vein is twisted here, and the gland is also visible farther down because the venacava is turned down, revealing its posterior aspect, and no venous tributaries flow from it.
Renal vein
Right Renal Artery
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Contraindication
Fibromuscular Dysplasia
Renovascular Hypertension
Economic shortage
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Vascular anomalies increase the difficulty during live donor nephrectomy. We herein report a left-sided retroperitoneoscopic living donor nephrectomy performed in a donor with a duplicated inferior vena cava (IVC). Computed tomography angiography provided accurate delineation of the venous anatomy and allowed preoperative planning. The duplicated IVC was clipped and divided just below its confluence with the left renal vein. The length of the left renal vein was sufficient for anastomosis in the recipient, and the recipient's serum creatinine was 1.21% on day 7. The donor made an uneventful recovery. Duplicated IVC is not a contraindication for left retroperitoneoscopic donor nephrectomy.
Contraindication
Renal vein
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Contraindication
Fibromuscular Dysplasia
Renovascular Hypertension
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Acute tubular necrosis
Renal vein
Renal vein thrombosis
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Evaluation for prospective donors in live-related renal transplantation poses many challenges. Anatomical anomalies are no longer considered red flags as long as the functionality is maintained. Vascular anomalies increase difficulty during live donor nephrectomy. We herein report a case of live donor nephrectomy in a donor with a duplicated left-sided inferior vena cava (IVC). Adequate length of the left renal vein was got by taking a cuff off the duplicated IVC. The postoperative period was uneventful. Duplicated IVC is not a contraindication for left donor nephrectomy and detailed preoperative imaging helps in delineating and planning such cases.
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Renal vein
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Objective To investigate the methods for increasing the success rate of living related donor kidney with short vessels transplantation.Methods Twenty-two cases of living related donor were chosen,in which 16 specimens of kidney from left side and 6 from right side were acquired.The length of renal arteries and veins were about 2 cm.During the kidney transplantation,the external iliac artery and vein of acceptor were dissociated fully and anastomosed with the artery and vein of the donor kidneys. If the operation space was still narrow and influencing the anastomosis of the blood vessel,the transplant kidney could be flushed continually with ice saline to maintain low temperature. Results The surgery time for taking the kidney was (180±30)mins,the blood creatinine of the donors increased after the operation and falls to the normal range in 6~10ds,the average hospital stay was(7±3)ds. The surgery time for kidney transplantation was (160±25)mins,the time for the transplant kidney function restored to normal was 3~15ds,the average hospital stay was (17±4)ds.Reexamination of vascular ultrasound showed that there were no thrombus appeared in the kidney artery and vein ,or the iliac vein and femoral vein. No acute kidney tubular necrosis appeared. Conclusion It can improve the success rate of Living related donor kidney with short vessels transplantation to dissociate the external iliac artery and vein sufficiently and flush the kidney continuously with ice saline instead of kidney bag,and also is safe.
Acute tubular necrosis
External iliac vein
External iliac artery
Renal vein
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Objective To establish a modified rat model of kidney transplantation.Methods 120 Wistar rats were used for kidney transplantation.Infusion was conducted at prime position.During or- thotopic kidney transplantation,donor's renal artery and renal vein were end-to-end anastomosed to renal artery and renal vein of the recipient respectively and donor's ureter directly implanted in bladder of the re- cipient.Results A modified rat model of kidney transplantation was successfully established with the suc- cessful rate being 90%.The average time of warm ischemia and cold ischemia was less than 3 s and(40±5)min respectively.The average time of vascular anastomosis was 35min.The average total time of opera- tion was(160±10)min.Conclusion The model could be repeated stably and be suitable for investiga- tion of the immune mechanism of organ transplantation.
Renal vein
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Tao R, Shapiro R. Successful adult-to-child renal transplantation utilizing the ovarian vein in children with inferior vena cava/iliac vein thrombosis.Pediatr Transplantation 2010: 14:E70–E74. © 2009 John Wiley & Sons A/S. Abstract: IVC/iliac vein thrombosis has previously been considered to be a contraindication to renal transplantation because of the technical difficulties and the increased risk of graft thrombosis. We report two successful cases of adult-to-child kidney transplantation in which we anastomosed the graft renal vein to the recipient ovarian vein in the presence of IVC and/or iliac vein thrombosis, with no short or long term vascular complications. Our experience, which adds to the successful reports from several other centers, suggests that the inability to use the iliocaval axis should no longer be considered a contraindication to pediatric renal transplantation.
Contraindication
Renal vein
Ovarian vein
Renal vein thrombosis
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