Experience with Renal Autotransplantation: Typical and Atypical Indications.

Ali Bourgi,Rana Aoun,Elias Ayoub,Maroun Moukarzel

doi:10.1155/2018/3404587

Abstract

Introduction and Objectives 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. Materials and Methods 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. Results 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. Conclusion 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.

Highlights

Introduction and ObjectivesRenal autotransplantation is a kidney-saving surgical procedure used in selected patients. e 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
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. is was maintained in 8 patients during the early follow-up (Figure 1)

Summary

Introduction

Renal autotransplantation (RA) is a rare, safe, and effective surgical procedure for the treatment of complex urologic conditions. Managing renal disease via a “benchwork” approach soon became a novel idea pursued worldwide by surgeons [1] After this landmark surgery, RA has been steadily improved to a safe and effective procedure and has been used in the treatment of different complex urologic diseases like extensive ureteric injuries, complex nephrolithiasis, loinpain syndrome, renovascular diseases (stenotic lesions of distal renal arteries, intrarenal aneurysms, and arteriovenous malformations), tumors of the kidney and ureter, and retroperitoneal fibrosis [2], even more in rare and unusual critical situations. Operating time (hours) Duration of ischemia (min) Duration of hospitalization (days) Pre-op creatinine clearance (ml/min) Creatinine clearance at discharge (ml/min) Duration of follow-up (months) Creatinine clearance at the last follow-up (ml/min)

Materials and Methods

Results

Conclusion

Ethical Approval