DOI: http://dx.doi.org/10.18203/2349-2902.isj20205344

Right renal vein lengthening with cava patch in cadaveric donor kidney transplantation: cohort study

Jorge Martinez Ulloa-Torres, Idalia Parra-Avila, Paulo Gutierrez-Torres, Belem Arieth Chan-Canche, Daniel Moo-Rivas Carlos, Juan Pablo Baas-Cruz, Luis Fernanado Aguilar-Castillejos, Mauro Enrique Tun-Abraham, Jesus Manual Bernal-Mier

Abstract


Background: Right kidney transplant can become a surgical challenge, due to anatomical length disparity between the right and left veins. From 2011, lengthening of the right renal vein has been used in our program. The objective was to evaluate the outcome among kidney transplant recipients with or without the use of a cava patch, comparing safety, complications and patient / graft survival in both groups.

Methods: Retrospective single center cohort study between 2011-2020 in a Kidney transplant program at Mexico.

Results: 27 right cadaveric kidney transplant recipients were identified, 13 (48%) with and 14 (52%) without right renal vein lengthening (RRVL). Median overall operative time was 135 (120-157) minutes, with no significant difference between groups (p=0.181), even in overweight or obese recipients. Perioperative bleeding and postoperative drainage output was similar in both groups. There were two graft failures among recipients without RRVL one due to arterial bleeding and the other secondary to venous thrombosis. After one year of follow up, renal graft function and graft survival was similar in both groups.

Conclusions: RRVL technique is safe and facilitates anastomoses in complex cases. Although no statistically significant difference in operative time was found between the groups, the RRVL technique in overweight / obese patients was thirty minutes faster. Routine use of this technique is suggested in cadaveric donor right kidney transplants.


Keywords


Right kidney transplant, Cava patch, Bench-surgery

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References


Satyapal KS. The renal veins: a review. Eur J Anat. 2003;7(1):43-52.

Janschek EC, Rothe AU, Hölzenbein TJ. Anatomic basis of right renal vein extension for cadaveric kidney transplantation. Urology. 2004;63:660.

Arango O, Lorente JA, Bielsa O, Rijo E, Francés A, Fumadó L, et al. Alargamiento de la vena renal derecha en 120 trasplantes consecutivos. Análisis comparativo. Actas Urológicas Españolas. 2013;37(3):135-41.

Gante MAJ, Sánchez-Aguilar M, Tapia-Perez JH. Extension of Right Renal Vein in Renal Transplant from Deceased Donors: Cohort Study. Experimental and Clinical Transplantation. 2015;2:126-9.

Barry J, and Fuchs E: Right renal vein extension in cadaver kidney transplantation. Arch Surg.1978;113:300.

Lin C, Wang K, Wang H, Wang J, Liu Q, Yu S, et al. Right renal vein elongation using gonadal vein during retroperitoneoscopic living donor kidney transplantation: a single-center experience. Clinical Transplantation. 28(12):1303-4.

Mirkey Estrada Castillo, Georis Pérez Cruz , Tomás de Armas Gil, et.al. Elongación de la vena renal derecha para el trasplante con la vena renal izquierda. Rev Cubana Urol. 2019;8(2):136-40.

Martínez AGJ, Regueiro DP, Boned MAT. Transplante renal. Técnica y complicaciones. Actas Urol Esp. 2003;27(9):662-77.

Tinay I, Temiz Y, Ilker Y. An Alternative for Short Renal Vein During Kidney Transplantation: Long-term Experience With Polyethylene Terephthalate (Dacron) Vascular Graft. Urology. 2013;82:245e247.

Kamel MH, Thomas AA, Mohan P, Hickey DP. Renal vessel reconstruction in kidney transplantation using a polytetrafluoroethylene (PTFE) vascular graft. Nephrol Dial Transplant. 2007;22(4):1030‐32.

Baptista-Silva JC, Medina-Pestana JO, Verissimo MJM. Right renal vein elongation with the inferior vena cava for cadaveric kidney transplants. An old neglected surgical approach. Int. braz j urol.Vol. 2005;31(6):519-25.

Elisabeth CS, Janschek, Rothe AU, Holzenbein TJ. Anatomic basis of right renal vein extension for cadaveric kidney transplantation. Urol. 2004;63:660-4.

Enriquez TG. The Right Renal Vein Extension: Technical Review. Int J Transplant & Plastic Surg 2019;3(S1):000S1-001.

E Benedetti , J Fryer, A J Matas, D E Sutherland, et al. Kidney Transplant Outcome With and Without Right Renal Vein Extension. Clin Transplant. 1994;8(4):416-7.

Vinson AJ, Rose C, Kiberd BA. Factors Associated With Prolonged Warm Ischemia Time Among Deceased Donor Kidney Transplant Recipients. Transplant Direct. 2018;4(5):e342.

Secasanu V, Nibhanupudy B, Chin T, Angelis M. Renal transplantation with unusual vasculature. Transpl Int. 2013;26(3):e22‐e24.

Aktas S, Boyvat F, Sevmis S. Analysis of Vascular Complications After Renal Transplantation. Transplantation Proceedings. 2011;43(2):557-61.

Carrel A, and Guthrie C. Anastomosis of blood vessels by the patching method and transplantation of the kidney. JAMA. 1906;17:1648-51.

Englesbe MJ. In: Operative Techniques in Transplantation Surgery. Lippincott Williams. 2014.