A Rarely Used Surgical Technique of Adult En Bloc Renal Transplant.

OBJECTIVE

We report the first en bloc adult deceased-donor renal transplant at our center. We had a an extended criteria, female, deceased donor, who was a known hypertensive, hypothyroid, with a history of Hodgkin lymphoma that had been treated successfully 30 years prior without recurrence. Her cause of death was intracranial hemorrhage. In view of the raised creatinine level at the time of donation, the transplant team decided to accept the kidneys for dual transplant. We decided to use a technique that is used to recover pediatric en bloc kidneys in our adult deceased donor.

METHODS

The kidneys were recovered en bloc with the aorta and inferior vena cava. Meticulous back table work was required in ligating all the nonrenal tributaries of the donor aorta and inferior vena cava. We anastomosed the aorta to the common iliac artery in an oblique end-to-side fashion. The donor inferior vena cava was anastomosed to the external iliac vein in an end-to-side fashion. The distal ends of ureters were made into a common lumen with a side-to-side anastomosis, and this common ureter was implanted into the bladder.

RESULTS

There was no requirement for postoperative dialysis. The creatinine is at nadir of 88 μmol/L at 1 year of follow up.

CONCLUSIONS

This is a method that can be attempted for implanting dual kidneys on one side. Kidneys with multiple vessels can be transplanted like a single kidney with a shorter cold ischemia/overall operative time and less fatigue for the surgeon.