Living-related transplantation of an ectopic pelvic kidney.

Abstract

Living-Related Transplantation of an Ectopic Pelvic Kidney. Transplantation 2004; 77: 953. E. L. Grogan, W. A. Nylander, D. Shaffer Physicians are forced to explore alternative sources of potentially transplantable kidneys because of the current organ shortages. Grogan et al. have followed this premise and describe a living-related transplantation of an ectopic pelvic kidney. Their case proves that even a so-called marginal kidney can be successfully transplanted. The donor’s health must always prevail when considering living transplantation. Extensive donor evaluation is therefore mandatory if a potential donor happens to harbor a “marginal” kidney such as an ectopic pelvic kidney or a horseshoe kidney. Visualizing techniques including selective Seldinger angiography or magnetic resonance angiography and intravenous pyelography are required for optimal operative planning. These techniques are needed because congenitally malformed kidneys are known to exhibit a great variety in number, origin, and size of renal arteries and veins (1). Although one could consider leaving the ectopic pelvic kidney in situ and explanting the technically less-demanding normal kidney, thus reducing the risk of perioperative complications, one must always leave the normal kidney in situ. Otherwise, possible future urologic complications occurring in a solitary remaining ectopic pelvic kidney, such as urinary calculi and hydronephrosis, may cause the donor to lose kidney function (1). The variation in vascular anatomy may make transplantation of ectopic pelvic kidneys and horseshoe kidneys technically more demanding than regular procedures. Horseshoe kidney transplantation is even more challenging because the renal isthmus has to be divided in situ, which may cause serious donor complications as reported in one of the two known cases (2). However, Grogan et al. demonstrated that a thorough evaluation followed by proper surgical techniques can lead to a successful transplantation of the ectopic pelvic kidney. We propose to use the term “marginal” when combined with “ectopic pelvic kidneys” as “reflecting the amount of transplantation experience” rather than the “quality of the kidney.” Ectopic pelvic kidneys may provide another small but welcome source of organs for transplantation.