Renal autotransplantation – reappraisal of an old technique

Abstract

Abstract Objective Transplantation of the patient’s own kidney into the iliac fossa has been described already more than 50 years ago, predominately for the treatment of renal trauma or peripheral renal artery aneurysms. The technique is however rarely used. We describe our experience with renal autotransplantation. Methods Retrospective analysis of consecutive patients. Results We performed renal autotransplantation in 3 patients from 2017-2019. The first patient was a 72y old male who had previously multiple stents placed in both renal arteries for renal artery stenosis and presented with a high grade in-stent stenosis of the right renal artery, complete occlusion of the left renal artery and left renal atrophy. The second patient was a 56y old male who presented with a 29mm aneurysm in the bifurcation of the left renal artery. The third patient was a 29y female with Takayasu disease, who had undergone endarterectomy of the abdominal aorta and vein bypass to the left renal artery as a child and stenting of the abdominal aorta for restenosis. She presented with aneurysmatic dilatation and high-grade restenosis of the vein bypass to the left renal artery. In the first two patients, laparoscopic nephrectomy via a retroperitoneal approach was performed as for living donor nephrectomy. The patient with the renal artery aneurysm had back table resection of the aneurysm and reconstruction by forming a common ostium of the two branch arteries. In the third patient, we explanted the kidney via laparotomy. In all patients, the kidney was perfused with cooled organ preservation solution after a brief period of warm ischemia and transplanted in the iliac fossa in standard fashion. After a median follow-up of 20 months (range 9-31) all autotransplanted kidneys showed good perfusion with no signs of renal artery stenosis. Median creatinine clearance was 97ml/min/1.7m2 (range 59-118). Conclusion Renal autotransplantation is a safe and durable procedure worth remembering when evaluating the treatment options of complex renal artery pathologies. Its use can also be envisaged for the treatment of complex renal trauma or complex ureter lesions.