Research Article: Experience with Renal Autotransplantation: Typical and Atypical Indications

Date Published: March 26, 2018

Publisher: Hindawi

Author(s): Ali Bourgi, Rana Aoun, Elias Ayoub, Maroun Moukarzel.

http://doi.org/10.1155/2018/3404587

Abstract

Renal autotransplantation is a kidney-saving surgical procedure used in selected patients. The purpose of this report is to review nine typical and atypical indications for kidney autotransplantation and evaluate its effectiveness in maintaining kidney function and avoiding cancer recurrence.

From 1999 till 2014, nine renal autotransplantations were performed in our center. A retrospective case review was done. Four of nine patients had a solitary functioning kidney. Typical indications for autotransplantation included extended ureteric disease in 5 patients, intrasinusal tumor on a solitary kidney in 1 patient, and renal artery aneurysm in 1 patient. Atypical indications consisted in bilateral urothelial tumors in 1 patient and interrupted live kidney transplantation in 1 patient. Mean cold ischemia time was 209 minutes. Demographic factors, indications, renal function before and after surgery, and in the long term, cancer recurrence and disease-free survival were evaluated.

Renal function was maintained in 8 patients during the early follow-up. No serious complications occurred in the postoperative period. Median duration of follow-up was 50 months. In 4 patients with a normal contralateral kidney, mean preoperative and at discharge creatinine clearance were 105.45 ml/min and 121.02 ml/min, respectively. Although values showed an improvement in the kidney function, the difference was not significant (p value 0.3). In the other 4 patients with a solitary kidney, mean discharge creatinine clearance was 99.24 ml/min surprisingly higher than the preoperative value 96.92 ml/min. At the last follow-up, kidney function was preserved for the two groups (normal contralateral kidney/solitary kidney) with relatively stable creatinine clearance values: 108.45 ml/min and 85.9 ml/min, respectively. No patients required secondary dialysis.

Renal autotransplantation is a rare, safe, and effective surgical procedure for the treatment of complex urologic conditions. In some instances, it may be of great utility for kidney salvage in some carefully selected patients.

Partial Text

Renal autotransplantation (RA) is a rare, safe, and effective surgical procedure for the treatment of complex urologic conditions. It was first reported by J. D. Hardy in 1963 when he repaired a high ureteric injury following aortic surgery by reimplanting the repaired organ into the ipsilateral iliac fossa.

From 1999 till 2014, nine renal autotransplantations were performed in our center (Hotel Dieu de France University Hospital). A retrospective case review was done. The series included five females and four males with a mean age of 49.8 years. 4/9 patients had a solitary functioning kidney. Typical indications for autotransplantation included extended ureteric disease in 5 patients, intrasinusal tumor on a solitary kidney in 1 patient, and renal artery aneurysm in 1 patient. Atypical indications consisted in bilateral urothelial tumors in 1 patient and interrupted live kidney transplantation in 1 patient.

Renal function was evaluated by creatinine clearance estimate using the Cockcroft–Gault equation. This was maintained in 8 patients during the early follow-up (Figure 1).

The main reason for the use of kidney autotransplantation is to preserve renal parenchyma. RA is generally reserved to severe situations and is often the last option before nephrectomy. Previous studies have emphasized AR as a highly effective surgical procedure for the treatment of renal pathologies.

Renal autotransplantation is a rare, safe, and effective surgical procedure for the treatment of complex urologic conditions. In some instances, it may be of great utility for kidney salvage in some carefully selected patients. Our center’s experience in renal autotransplantation showed low complications rate, preserved kidney function, and no cancer recurrence on the early and late follow-up.

 

Source:

http://doi.org/10.1155/2018/3404587

 

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