Abstract
In this clinical serial, we would like to introduce a surgical technique for kidney transplantation (KTx) from living donor (LD); we call the vessel disposition technique (VDT), with long-term follow-up results. A prospective study at Cho Ray Hospital. The patients underwent the KTx from 1998-2011 and following-up until 2016. There were 201pts., 130 males (64.7%) and 71 females (35.3%). Average age is 33.56 ± 8.62 year old (yo), [15 to 61yo]. We divided it into two groups (at the back table and recipient surgical table): Group A: The Kidney graft (KG) with short vein (≤20 mm) was transplanted on right iliac fossa: 63/201pts. (31.34%), 13/63 from the left (20.63%) and 50/63 from the right (79.37%): the renal vein was dissected, liberated and prolonged; for the right KG, a renal VDT would be done. On the pts., right Gibson incision, made an iliac VDT: dissection of the right iliac vessels (RIV), moved the external iliac vein (IV) to the right side of the external iliac artery; and a termino-lateral venous anastomosis. The renal artery anastomosis would be done as usual. Group B: The KG with the long vein enough (>20 mm) was also transplanted on RIF: 138/201pts (68.66%). Usually, the KG is the left, the KTx was performing as usual, vascular postoperative follow-up by Doppler ultrasound. There wasn’t any surgical vascular complication during the average FU of: 8.0±3.44 years (group A) and 8.79±4.07 years (group B). During the long time follow-up on the serial, the VDT was satisfactory. The KTx from LD was safety for the short KG vein and we could perform on the right side of the pts for the left and the right KG. We could avoid other risky venous reconstructive techniques.
Highlights
There are 2 problems for the surgical technique in KTx: (1) traditionally, the left Kidney graft (KG) will be transplanted in the RIF and the right KG will be in the LIF, but KTx become difficult and more risky if KG vein is short; (2) There are currently some suggestions as solution for surgical techniques, there current available techniques may be reconstruction for venous extension of the KG [1,2,3,4,5,6], or iliac vessel (IV) transposition [7, 8]
The study were homogeneous because only one group performed during the study period, we would like to introduce our experience for these problems with the vessel disposition technique (VDT), on the recipients and on the KG
On the pts: the right Gibson incision was made and the iliac VDT would be done: the right iliac vessels (RIV) and the RIA were dissected, venous branches were ligated and cut, the external RIV was moved to the right side of the external RIA; the termino-lateral venous anastomosis would be done, continuous suture by Prolene 6 or 7.0
Summary
There are 2 problems for the surgical technique in KTx: (1) traditionally, the left KG will be transplanted in the RIF and the right KG will be in the LIF, but KTx become difficult and more risky if KG vein is short; (2) There are currently some suggestions as solution for surgical techniques, there current available techniques may be reconstruction for venous extension of the KG [1,2,3,4,5,6], or iliac vessel (IV) transposition [7, 8]. We have evaluated to apply the VDT for KG at the back table and the recipient theater. The study were homogeneous because only one group performed during the study period, we would like to introduce our experience for these problems with the VDT, on the recipients and on the KG. The report is results of study on VDT for long-term follow-up
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