Orthotopic kidney transplantation is a possible solution in difficult situations
https://doi.org/10.23873/2074-0506-2025-17-1-10-18
Abstract
Background. Kidney transplantation is the most preferable definitive treatment for the end-stage renal disease. Often, patients who need an organ transplantation have peculiar anatomical features that require a non-standard approach to performing this surgery.
Objective. To present a clinical case of orthotopic kidney transplantation in a patient with occlusive thrombosis of the external iliac veins.
Material and methods. A 31-year-old patient with stage 5 chronic kidney disease and occlusive thrombosis of the external iliac veins being prepared for a related donor kidney transplantation.
Results. Orthotopic kidney transplantation was performed. In order to ensure a sufficient length of the donor kidney artery and the convenience of its anastomosis, a segment of the recipient's splenic artery was used. The venous and ureteral segments of the graft were anastomosed end-to-end with the recipient's renal vein and ureter, respectively. After the surgery completion, the graft function was immediate. In the postoperative period, three-component immunosuppressive therapy was used. At the time of discharge, plasma creatinine was 0.15 mmol/L.
Conclusion. Orthotopic kidney transplantation should be considered as an alternative solution in case of obliteration, thrombosis or atherosclerotic lesion of the recipient's iliac vessels. The method can be used in recipients with two or more previous transplants.
About the Authors
D. V. Perlin
Volgograd Regional Uronephrological Center; Volgograd State Medical University
Russian Federation
Russian Federation
Dmitriy V. Perlin, Prof., Dr. Sci. (Med.), Chief Physician; Head of the Department,
86, General Karbyshev St., Volzhsky, Volgograd region, 404120;
1, Fallen Fighters Sq., Volgograd, 400066.
A. V. Terentyev
Volgograd Regional Uronephrological Center; Volgograd State Medical University
Russian Federation
Russian Federation
Alexey V. Terentyev, Urologist, Department of Urology; Assistant of the Department of Urology,
86, General Karbyshev St., Volzhsky, Volgograd region, 404120;
1, Fallen Fighters Sq., Volgograd, 400066.
T. S. Vasiliev
Volgograd Regional Uronephrological Center
Russian Federation
Russian Federation
Timur S. Vasiliev, Urologist, Dialysis Department,
86, General Karbyshev St., Volzhsky, Volgograd region, 404120.
Ya. N. Dankov
Volgograd Regional Uronephrological Center
Russian Federation
Russian Federation
Yaroslav N. Dankov Urologist, Department of Urology,
86, General Karbyshev St., Volzhsky, Volgograd region, 404120.
References
1. Musquera M, Peri L, Álvarez-Vijande R, Ajami T, Alcaraz A. Orthotopic renal transplantation: indication, technique and outcomes. Curr Urol Rep. 2020;21(2):14. PMID: 32166462 https://doi.org/10.1007/s11934-020-0965-6
2. Suttle T, Fumo D, Baghmanli Z, Saltzman B, Ortiz J. Comparison of urologic complications between ureteroneocystostomy and ureteroureterostomy in renal transplant: a meta-analysis. Exp Clin Transplant. 2016;14(3):276– 281. PMID: 26925612 https://doi.org/10.6002/ect.2015.0161
3. González J, Jue JS, Farag A, Ciancio GC. Bases anatómicas del trasplante renal [Renal allograft transplant: Anatomic description.]. Arch Esp Urol. 2021;74(10):922–932. PMID: 34851307
4. Serrell EC, Su R, O'Kelly F, Semanik M, Farhat WA. The utility of native ureter in the management of ureteral complications in children after renal transplantation. Pediatr Transplant. 2021;25(7):e14051. PMID: 34056809 https://doi.org/10.1111/petr.14051
5. Goodfellow M, Thompson ER, Tingle SJ, Wilson C. Early versus late removal of urinary catheter after kidney transplantation. Cochrane Database Syst Rev. 2023;7(7):CD013788. PMID: 37449968 https://doi.org/10.1002/14651858.CD013788.pub2
6. Dadkhah F, Sofimajidpour H, Aliaskari M, Airezaei A, Taleghani S, Rasouli MA, et al. Long-term results of posterolateral extravesical ureteroneocystostomy and its comparison with the conventional anterior extravesical ureteroneocystostomy method in the management of urologic complications in kidney transplant patients. Urol J. 2022;19(2):120–125. PMID: 35075625 https://doi.org/10.22037/uj.v18i.6449
7. Mazhar HR, Aeddula NR. Renal vein thrombosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 12, 2023. PMID: 30725656
8. Xie L, Zeng X, Xia Q, Peng J, Liu F, Chen J, et al. Reconstruction of a transplant recipient's external iliac artery using donor's inferior vena cava in renal transplantation: 2 case reports. Transplant Proc. 2021;53(3):828–832. PMID: 33004221 https://doi.org/10.1016/j.transproceed.2020.08.035
9. Territo A, Selvi İ, Malçok A, Boissier R, Campi R, Prudhomme T, et al. Graft survival and postoperative complications following orthotopic renal transplantation. Clin Transplant. 2024;38(1):e15220. PMID: 38078675 https://doi.org/10.1111/ctr.15220
10. Verghese P, Minja E, Kirchner V, Chavers B, Matas A, Chinnakotla S. Successful renal transplantation in small children with a completely thrombosed inferior vena cava. Am J Transplant. 2017;17(6):1670–1673. PMID: 28133953 https://doi.org/10.1111/ajt.14213
11. Queiroz AB, Campos Júnior W, Puech-Leão P, De Luccia N. Absence of the infrarenal inferior vena cava. J Vasc Surg. 2015;62(6):1641. PMID: 26598121 https://doi.org/10.1016/j.jvs.2014.05.003
12. Millan M, Caicedo LA, Villegas JI, Serrano O, Caicedo L, Duque M, et al. Case report of cadaveric kidney transplantation with renal-portal venous drainage: a feasible way for a venous drainage in a complex generalized thrombosed vessels setting. Int J Surg Case Rep. 2016;28:192–195. PMID: 27718439 https://doi.org/10.1016/j.ijscr.2016.09.047
13. Spaggiari M, Di Bella C, Di Cocco P, Furno S, Benedetti E, Tzvetanov I. Emergency kidney transplantation in recipients with iliocaval thrombosis using splenic vessel anastomosis after splenectomy: a case series. Transplant Proc. 2018;50(1):99–103. PMID: 29407339 https://doi.org/10.1016/j.transproceed.2017.12.009
14. Lorenzo AJ, Taylor K, Farhat WA, Gnech M, Rickard M, Koyle MA. Is there a functional disadvantage to using the external iliac vessels for vascular anastomosis in children and adolescents undergoing renal transplantation? Pediatr Transplant. 2019;23(4):e13398. PMID: 30916849 https://doi.org/10.1111/petr.13398
15. Hevia V, Gómez V, Álvarez S, DíezNicolás V, Fernández A, Burgos FJ. Orthotopic kidney transplant: a valid surgical alternative for complex patients. Curr Urol Rep. 2015;16(1):470. PMID: 25404184 https://doi.org/10.1007/s11934-014-0470-x
16. Gutiérrez-Zurimendi G, ZabalaEgurrola JA, Lecumberri-Castaños D, Urresola-Olabarrieta A, EzquerroImas A, Cambón-Bastón EM, et al. Trasplante renal ortotópico (TRO): una alternativa cuando el heterotópico no es posible [Orthotopic kidney transplant (OKT): An alternative when heterotopic transplant is not feasible.]. Arch Esp Urol. 2021;74(3):293–298. PMID: 33818425
17. Hotta K, Miura M, Tanaka T, Tanabe T, Masumori N, Shinohara N. Surgical strategy for orthotopic kidney transplantation. Int J Urol. 2024;31(5):582–584. PMID: 38297483 https://doi.org/10.1111/iju.15418
18. Phillips BL, Callaghan CJ. Graft nephrectomy in children. Pediatr Nephrol. 2018;33(6):947–955. PMID: 28631039 https://doi.org/10.1007/s00467-017-3697-1
19. Aikawa A, Muramatsu M, Takahashi Y, Hamasaki Y, Hashimoto J, Kubota M, et al. Surgical challenge in pediatric kidney transplant vascular anastomosis. Exp Clin Transplant. 2018;16(1, Suppl 1):14–19. PMID: 29527984 https://doi.org/10.6002/ect.TOND-TDTD2017.L41
20. Feng JY, Huang CB, Fan MQ, Wang PX, Xiao Y, Zhang GF. Renal vein lengthening using gonadal vein reduces surgical difficulty in living-donor kidney transplantation. World J Surg. 2012;36(2):468–472. PMID: 21882021 https://doi.org/10.1007/s00268-0111243-z
21. de Cerqueira JBG, de Oliveira CMC, Silva BGB, Santos LCO, Fernandes AG, Fernandes PFCBC, et al. Kidney transplantation using gonadal vein for venous anastomosis in patients with iliac vein thrombosis or stenosis: a series of cases. Transplant Proc. 2017;49(6):1280– 1284. PMID: 28735994 https://doi.org/10.1016/j.transproceed.2017.02.058
22. Shishido S, Kawamura T, Hamasaki Y, Takahashi Y, Itabashi Y, Muramatsu M, et al. Successful kidney transplantation in children with a compromised inferior vena cava. Transplant Direct. 2016;2(6):e82. PMID: 27500272 https://doi.org/10.1097/TXD.0000000000000592
23. Nédélec M, Glémain P, Rigaud J, Karam G, Thuret R, Badet L, et al. Transplantation rénale sur prothèse vasculaire [Renal transplantation on vascular prosthesis]. Prog Urol. 2019;29(12):603611. PMID: 31447181 https://doi.org/10.1016/j.purol.2019.06.005
24. Gil-Vernet Vila JM. Descripción de una vía de acceso retroperitoneal a los vasos del bazo para las anastomosis esplenorrenales arteriales y venosas [Description of a retroperitoneal access route to the vessels of the spleen for splenorenal arterial and venous anastomosis]. An R Acad Nac Med (Madr). 2014;131(1):27-40. PMID: 27386671
25. Castillo-Delgado CA, García-Perdomo HA, Musquera M, Alcaraz A. Orthotopic kidney transplantation survival and complications: systematic review and meta-analysis. Arab J Urol. 2022;20(4):212–218. PMID: 36353475 https://doi.org/10.1080/2090598X.2022.2090133
Review
For citations:
Perlin D.V., Terentyev A.V., Vasiliev T.S., Dankov Ya.N. Orthotopic kidney transplantation is a possible solution in difficult situations. Transplantologiya. The Russian Journal of Transplantation. 2025;17(1):10-18. https://doi.org/10.23873/2074-0506-2025-17-1-10-18
Views:
640
