De Novo Techniques that Facilitate the Transplant of Short Right Allograft Kidney Vein as Left Allograft Kidney from Live Donor

doi:10.4236/ojots.2012.22002

Paper Menu >>

Journal Menu >>

Open Journal of Organ Transplant Surgery, 2012, 2, 5-7

http://dx.doi.org/10.4236/ojots.2012.22002 Published Online May 2012 (http://www.SciRP.org/journal/ojots) 5

De Novo Techniques that Facilitate the Transplant of Short

Right Allograft Kidney Vein as Left Allograft Kidney from

Live Donor

Afshar Zomorrodi, Farzad Kakaei, Shar Zomorrodi

Kidney Transplant Ward Imam Reza Hospital, Tabriz Medical Science University, Tabriz, Iran

Email: [email protected]

Received December 26, 2011; revised February 13, 2012; accepted February 25, 2012

ABSTRACT

The Kidney transplant is preferred option for treatment of chronic renal failure because with this modality treatment the

life quality of patient is like normal also this modality is cost effective. The left allog raft is cho ice for tran splan t because

the short right renal vein predisposes this allograft for more complication. We introduce methods, which facilitate the

anastomosing the short right allograft vein and probably reduce the vascular complication. Methods: In 20 right al-

lograft kidneys after irrigation, with dissection between vein and artery near the hilum at the back table, placing the al-

lograft kidney with inversion position and external iliac artery selection an d first vein anastomosing and h eparin injec-

tion transplan tation is carried ou t and all the recipients are treated with three drugs (predniso lone, cyclosporine cellcept)

and follow up is conducted . Results: In these cases, with at least six months follow up , f low of the u r ine an d cir culatio n

of blood were normal. Conclusion: With regarding the results it may be concluded that with this technique it may re-

duces the vessel complication and facilitates the vessel anasto mosing of the right allograft kidney.

Keywords: Right Side Allograft; Surgical Complication; Renal Vein; Vein Thrombosis

1. Introduction

Still, the kidney transplant is the best option for the

chronic renal failure patien ts, because with this treatment

the reaching of two important goals (normal lifestyle and

cost effective) is possible. The survival of recipient and

the graft survival have been improved by the time it is

due to improving immunosuppressive and technique. The

important obstacle with kidney transplant is shortage of

the kidney donor, at challenging for the short ag ing of the

donors some centers not only accepting the deceased

donors but also they accept relative and unrelative live

donor for transplant. The success rate of the transplant

center depends on many factors, including: center de-

pending, the recipient depending and donor depending

[1].

The donor factors including: age and gender and side

of nephrectomy [2].

Many studies have done for the effect of side at the

outcome of kidney transplant, and they concluded that

there is not any different between right and left allograft

kidney, but the most importing point in these studies is

that the study is about a deceased donor and the late

complication but not about live donor and early compli-

cation [3-6]. But in the live donor, the side of nephrec-

tomy is effective in the outcome of the transplant and

early surgical complication.

At the live donor, the selection of side depends on the

function and the anatomy of kidney. First of all the kid-

ney with the best function is remained for the donor and

second if the function of two kidneys comparable the

anatomic selection is a choice.

Sometimes the right side kidney must be selected so in

that case, there is the surgical problem which depends on

the short length of a vein if it doesn’t be a good job, there

will be an early surgical problem as thrombosis of the

vein. With techniqu es that we introduce in this article the

anastomosing of the short length of the right renal vein

may be comparable with the left long renal vein.

2. Methods and Material

Twenty kidney recipients (15 males, five females since

2008) with age rang 55 - 65 in them right allograft kid-

ney has been selected for placement in the right iliac

fosse. First in the back table, the vein and the artery of

kidney carefully separated and some small connection in

the vessel of artery and vein carefully liquated this care-

ful dissection causes some increase the length of the vein.

In the recipient before clamping vessel heparin in a dose

A. ZOMORRODI ET AL.

of 30 units per kilogram are injected. Right allograft

kidney placed in the right iliac fosse in the inversion po-

sition, and both the external iliac vessels (artery and vein)

are selected for anastomosing, and at first the renal vein

is anastomosed to the extern al iliac, and second the renal

artery anastomosed to external iliac artery, consequently.

Post operation all the recipients are controlled with cal-

cineurin inhibitor and cellcepts and corticosteroid.

3. Results

Post operation all the patient were followed with color

Doppler ultrasound and Para clinical evaluation, urinary

flow and blood circulation follow were normal (at least 6

months they were followed).

4. Discussions

Still the right side allograft kidney from a live related or

unrelated donor has a more complications than left-side

allograft kidney [2]. But in deceased donor study (with

using vena cava for elongation of the short vein) the re-

sults of the left and the right allograft kidney were re-

ported as comparable [3-6] but in the live donor due to

the limited vena cava the prob lem of the short renal vein

is remained and this problem predisposes the vein for

thrombosis [7,8] in our suggestion method, it can be

found easily that without inversion of the right allograft

kidney Figure 1 the renal vein is reached to the external

iliac vein under the tension and post inversion of the

right kidney allograft Figure 2 the renal vein is reached

Figure 1. Right allograft vein reaches with tension to the external iliac vein.

Figure 2. Right allograft post inversion the vein reaches to the external iliac vein without tension.

A. ZOMORRODI ET AL. 7

to the external iliac vein without more tension. Previ-

ously In our kidney transplant center there was a few

cases of kidney transplant that in them the allograft has

been placed in inversion position unknowingly but in

follow up they have not any urologic problem so it was

understood that inversion position from urologic stand-

point is safe. selection the external iliac artery support

the length of the renal vein because it causes the renal

vein of right allograft kidney placing directly in the front

of the external iliac vein without any deviation and first

anastomosing the renal vein support the length of renal

vein because in this condition the selection of place for

anastomosing on the external iliac vein is done freely and

unlimitedly (artery is long and free withou t leathering the

vein). Injection heparin is important in reducing throm-

bosis.

4. Conclusion

Our suggestion technique facilitates the right allograft

vein anastomosing and overall it seems to reduce the

early complication of the right allograft kidney trans-

plantation it is necessary to continue these techniques

with more cases to definitive finding.

REFERENCES

[1] D. W. Gjertson, “Multifactorial Analysis of Renal Trans-

plants Reported to the United Network for Organ Sharing

Registry,” Clinical Transplantation, 1992, pp. 299-317.

[2] N. J. Feduska, Jr. and J. M. Cecka, “Donor Factors,”

Clinical Transplantation, 1994, pp. 381-394.

[3] S.Hariharan, C. P. Johnson, B. A. Bresnahan, S. E. Tar-

nanto, M. J. McIntosh and D. Stablein, “Improved Graft

Survival after Renal Transplantation in the United States,

1988 to 1996,” New England Journal of Medicine, Vol.

342, No. 9, 2000, pp. 605-612.

[4] P. J. Phelan, W.Shields, P. O’Kelly, M.Pendergrass, J.

Holian, J. J. Walshe, C. Magee, D. Little, D. Hickey and

P. J. Conlon, “Left versus Right Deceased Donor Renal

Allograft Outcome,” Transplant International, 2009, Vol.

22, No. 12, pp. 1159-1163.

doi:10.1111/j.1432-2277.2009.00933.x

[5] M. Salehipour, A. Bahador, H. Jalaeian, H. Salahi, S. Ni-

keghbalian, F. Khajehee and S. A. Malek-Ho sseini, “C om-

parison of Right and Left Grafts in Renal Transplanta-

tion,” Saudi Journal of Kidney Diseases and Transplan-

tation, Vol. 19, No. 2, 2008, pp. 222-226.

[6] D. W. Johnson, D. W. Mudge, M. O. Kaisar, S. B. Camp-

bell, C. M. Hawley, N. M. Isbel, D. Wall, A. Griffin, J.

Preston and D. L. Nicol, “Deceased Donor Renal Trans-

plantation—Does Side Matter?” Nephrology Dialysis Tran s-

plantation, Vol. 21, No. 9, 2006, pp. 2583-2588.

doi:10.1093/ndt/gfl268

[7] E. D. Brown, M. Y. Chen, N. T. Wolfffian, D. J. Ott and

N. E. Watson, Jr., “Complications of Renal Transplanta-

tion: Evaluation with US and Radionuclide Imaging,”

RadioGraphics, Vol. 20, No. 3, 2000, pp. 607-622.

[8] A. K. Mandal, C. Cohen, R. A. Montgomery, L. R. Kavoussi

and L. E. Ratner, “Should the Indi cations for Lap ara sc op ic

Live Donor Nephrectomy of the Right Kidney Be the

Same as for the Open Procedure?” Transplantation, Vol.

71, No. 5, 2001, pp. 660-664.