V06-06 a Tale of Second Chances: Renal Allotransplantation After Ex Vivo Renal Artery Aneurysm Repair

You have accessJournal of UrologyMisc. Benign/ Transplant/ Renovascular (V06)1 May 2024V06-06 A TALE OF SECOND CHANCES: RENAL ALLOTRANSPLANTATION AFTER EX VIVO RENAL ARTERY ANEURYSM REPAIR Kaiying Wang, Benjamin Y. S. Goh, Mark E. Puhaindran, Sandeep J. Sebastin, and Ho Yee Tiong Kaiying WangKaiying Wang , Benjamin Y. S. GohBenjamin Y. S. Goh , Mark E. PuhaindranMark E. Puhaindran , Sandeep J. SebastinSandeep J. Sebastin , and Ho Yee TiongHo Yee Tiong View All Author Informationhttps://doi.org/10.1097/01.JU.0001010048.21113.99.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of hilar, saccular renal artery aneurysms (RAA) via nephrectomy, ex vivo RAA repair and kidney autotransplantation has been infrequently described. We describe a technique of ex vivo RAA repair followed by live donor kidney allotransplantation between a donor husband and recipient wife pair. METHODS: A 61 year-old male was incidentally noted to have a 1.8 cm saccular right RAA on pre-operative kidney donor workup. He underwent right nephrectomy via an open flank approach to ensure adequate length of arterial and venous vessels. The renal artery was then microsurgically reconstructed on table via a multi-disciplinary collaborative effort. The two anterior branches remained in continuity with the native artery, and formed the upper renal artery. The two posterior branches were anastomosed to a cadaveric iliac artery graft from an external tissue bank, and formed the lower renal artery. The kidney was then transplanted into the recipient. Renal vein was anastomosed to the right external iliac vein, and the upper and lower renal arteries were anastomosed to the proximal and distal right external iliac artery respectively. Intra-operatively, the posterior 30% of the transplanted kidney was noted to be dusky, and Doppler ultrasound confirmed poor flow in the lower renal artery. The distal anastomosis was taken down, and an intimal flap from atherosclerotic plaque was noted at the edge of the iliac graft where the anastomosis had been. The graft was trimmed down to healthy adventitia, and reanastomosis was done at the existing distal arteriotomy. Artery flow and kidney perfusion improved after reanastomosis. A Lich-Gregoir ureteroneocystostomy was created uneventfully and the operation concluded. RESULTS: The total operative time was 8 hours 0 minutes, inclusive of donor nephrectomy. Cold ischaemia time was 14 minutes. Warm ischaemia time was 55 minutes, with an additional 40 minutes due to time needed for reanastomosis. Estimated blood loss was 600 ml, and no blood transfusion was required. There was no delayed graft function, and the recipient did not require dialysis in the post-operative week. Imaging done up to 2 months post operatively showed patent vasculature with a well perfused transplanted kidney. 7 months post operatively, the recipient's eGFR was 54 mL/min/1.73 m2. CONCLUSIONS: Renal artery allotransplantation following ex vivo RAA repair is a viable procedure, with good outcomes for both recipient and donor. Atherosclerotic vessels may present challenges in vascular anastomosis, and arterial flow and organ perfusion should be ensured prior to skin closure. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e377 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kaiying Wang More articles by this author Benjamin Y. S. Goh More articles by this author Mark E. Puhaindran More articles by this author Sandeep J. Sebastin More articles by this author Ho Yee Tiong More articles by this author Expand All Advertisement PDF downloadLoading ...