Ipsilateral Placement in Double-Kidney Transplantation: An Old Technique in a New Fashion

Abstract

We read with interest the communication of Gaber et al. (1) from Memphis, Tennessee describing the ipsilateral (monolateral) placement of both adult deceased donor kidneys into a single recipient in double (dual) kidney transplantation (DKT). The first DKT was reported in 1996 by Johnson et al. (2) as shown in Gaber et al. article. The authors mentioned that there was no prior description available for monolateral positioning of DKT (MPDKT). We report that the first description of MPDKT was published in 1998 by Masson and Hefty (3) with a very similar figure of the technique as published by the Memphis group. In that report, no such detailed description of ipsilateral technique was given but the technique was described briefly. However, as it was the first report with the detailed figure of the technique, we believe that it should have been mentioned in such surgical technique article. Besides the first report by Masson and Hefty, we recently published 29 cases of MPDKT from marginal donors in an “old-for-old” allocation policy (4). In our report, we described the MPDKT technique in ample details in comparison with the first report and we provided a detailed figure of our technique in MPDKT. Interestingly, Gaber et al. (1) did not provide the figure of their surgical technique, especially of interest in vascular anastomoses. The authors mentioned that the preference of arterial anastomosis for the first kidney is proximal internal iliac artery after suture ligation of the distal end (1). However, the surgical artwork shows an end-to-side anastomosis, which is an option for the authors and which was already shown by Masson and Hefty (3) and our group (4). Besides, the authors described the same technique for ureteral anastomosis (combined) as Masson and Hefty. Approximately a decade after the description of the MPDKT in an adult recipient, the usage of DKT has recently blossomed because of the important increase of older deceased donors and their optimal usage at long term (5). The assessment of preoperative biopsy of older donor kidneys could be of help to the surgeons to perform either DKT, single kidney transplantation, or discard them (5, 6). The MPDKT has had particular interests reducing the operating time and surgical trauma, and leaving the contralateral iliac fossa for further retransplantation as much as it had many doubts because of compression of the anastomosed vessels and surgical hurdles of the technique itself especially on older recipients. Our group has reached more than 65 cases of MPDKTs using the described technique in previously published article (4) and we have experienced only one case of renal vein thrombosis in a patient with a heterozygousy for Factor V Leiden gene mutation (4, Ekser and Rigotti, Unpublished data). The question remains whether the technique described by the Memphis group would result in an actual novelty as a surgical procedure and also in the graft outcomes. We think that our previously described and refined surgical technique has so far yielded excellent operative and survival data. Burcin Ekser Lucrezia Furian Paolo Rigotti Kidney and Pancreas Transplantation Unit Department of Surgery and Organ Transplantation University of Padua Padua, Italy