101 AUTOTRANSPLANTATION - AN EXCELLENT CHOICE FOR EXCELLENT RESULTS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (II)1 Apr 2013101 AUTOTRANSPLANTATION - AN EXCELLENT CHOICE FOR EXCELLENT RESULTS Richard Johnston, Natalya Lopushnyan, Paul Kozlowski, and Thomas Hefty Richard JohnstonRichard Johnston Seattle, WA More articles by this author , Natalya LopushnyanNatalya Lopushnyan Seattle, WA More articles by this author , Paul KozlowskiPaul Kozlowski Seattle, WA More articles by this author , and Thomas HeftyThomas Hefty Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1479AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal autotransplantation has been described in the past as a management option for complex ureteral and renal vascular pathology. We report a single center's long-term outcomes and late complications after nephrectomy with autotransplantation for a variety of pre-operative indications. METHODS We retrospectively reviewed clinical data on all patients who underwent nephrectomy with auto transplantation between July 2007 and August 2012. Indications, intra- and perioperative complications as well as late complications were analyzed. RESULTS A total of 22 patients were identified. Autotransplantation of a solitary kidney was performed in 3 out of 22 patients. Indications for autotransplantation included complex ureteral stricture disease in 8 patients, 3 failed UPJ repairs, 3 renal artery aneurysms, 3 iatrogenic injuries resulting in long strictures, 2 patients with recurrent stone disease and pain, 1 retroperitoneal fibrosis, 1 desmoid tumor and a heminephrectomy of a large diverticulum with re-implantation. Median age at surgery was 49 years (range 25 to 74). Median follow up was 24 months. One patient (4.5%) required immediate re-operation due to renal artery thrombus, this patient's graft was saved with no long term impact on renal function. No patient required repeat surgery following initial discharge. All other grafts performed well with no discernible reduction in renal function over the follow up period. Mean Cr decreased overall from 1.19 to 0.96 mg/dL. CONCLUSIONS Complex ureteric or renal vascular abnormalities are difficult to manage. In selected patients autotransplantation provides safe and effective approach to prevent renal loss and preserve existing renal function. Urologists should continue to have some presence in the world of non autologus transplant to maintain the transplantation skills necessary to manage these complex cases. Difficult reconstructive cases should be referred to centres of excellence where these difficult cases are best managed. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e40-e41 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Richard Johnston Seattle, WA More articles by this author Natalya Lopushnyan Seattle, WA More articles by this author Paul Kozlowski Seattle, WA More articles by this author Thomas Hefty Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...