Perioperative Considerations for Renal Transplant Patients

INTRODUCTION: The kidney is the most commonly transplanted organ and renal transplant is the gold standard treatment for end-stage renal disease. Most kidneys are transplanted into the iliac fossa and usually pre-peritoneal, while the original kidneys are generally left in place. The altered location of the transplanted kidney and ureter as well as the patient’s complex medical history may present many challenges to the gynecologic laparoscopic surgeon. OBJECTIVE: To review preoperative, intraoperative, and postoperative considerations in renal transplant patients and to demonstrate the application of these considerations in a case of a patient with a transplanted kidney. METHODS: Surgical video highlighting perioperative considerations in a 37-year-old patient with a pelvic kidney and symptomatic fibroids undergoing a minimally invasive hysterectomy. RESULTS: This video demonstrates important perioperative considerations for renal transplant patients undergoing laparoscopic hysterectomy. Thorough preoperative planning is essential and includes review of imaging, current medication regimen, transplant history, baseline renal function, and consideration of ureteral stenting prior to surgery. Intraoperatively, we highlight important tips including placement of the uterine manipulator under laparoscopic guidance, careful placement of trocars, identification of the transplanted ureter, cautious intraoperative dissection, and tips to decrease the risk of impaired perfusion to the transplant kidney. Lastly, we highlight unique cystoscopy findings in transplant kidneys, as the ureter is often more anterior and located at the dome of the bladder. CONCLUSIONS: Caring for renal transplant patients can be challenging due to their complex medical history and altered anatomy. This video highlights important considerations to safely perform minimally invasive gynecologic surgeries for renal transplant patients.