A new operative technique of paratopic positioning of pediatric en bloc kidneys for transplantation

Technical difficulties and insufficient renal mass have been reasons not to use en bloc-removed kidneys from organ donors under the age of 3 years. We developed a new technique of paratopic positioning of en bloc-removed kidneys with a prolonging interpositional graft of donor aorta and vena cava. With transperitoneal approach, anastomosis directly to the recipient's aorta and vena cava can be performed. Using this technique, 7 patients have been transplanted so far. They were chosen out of a list of possible recipients according to HLA-match, body weight and blood pressure. All patients had primary function. Anastomosis and renal vessels were controlled by color duplex ultrasound imaging and angiography. Patients developed a stable kidney function. There were no surgical complications except a thrombosed kidney in 1 patient. With the new technique described, transplantation of en bloc-removed kidneys from donors under the age of 3 years can be performed with a low rate of technical complications. Donors of this age should be considered not only as potential liver donors but as kidney donors as well.