Variation of Kidney Graft Vessels During Laparoscopic Living Donor Tx

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VARIATION OF THE KIDNEY GRAFT VESSELS DURING LAPAROSCOPIC LIVING DONOR NEPHRECTOMY (LLDN): SURGICAL MANAGEMENT AND IMPACT ON EARLY GRAFT FUNCTION. Dimitri Mikhalski1, Alexis Buggenhout1, Patricia Loi1, Nilufer Broeders2, Vincent Donckier1, Daniel Abramowicz2 and Anh-Dung Hoang1 1 Dipartment Digestive Surgery and Transplantation Hopital Erasme 2 Department Nephrology Hopital Erasme Brussels

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Ronald Herrick died 2010 at age 79. In 1954, his identical twin brother, Richard, had end-stage kidney disease with little prospect of long-term survival. Dr Joseph Murray,

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Donor in Hopital Erasme

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20-25% of all kidney transplants in the world are performed with living donors.

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less post-operative morbidity, quicker convalescence and better cosmetic results. It increases the number of individuals willing to donate without increasing the risk to donors’ safety or allograft function. It should be used, whenever possible, only by appropriately trained and experienced surgeons. Laparoscopic nephrectomy offers donors USA

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three methods: • Medical methods: laparoscopic harvesting, paired kidney exchange, transplantation of grafts with anatomical abnormalities (vascular, urinary tract fusion) reversal of a positive cross-match by treatment with plasmapheresis and intravenous immunoglobulin administration. • Ethical: by showing appreciation for organ donation • Organizational: such as medical leave for organ donation and the reimbursement of all costs to the donor. The rate of living donation can be increased by

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Acceptance of grafts with anatomical anomalies: Most experienced transplantation centers, consider the relative contraindication for using grafts with anatomical anomalies, renal cysts, uretero-pelvic junction obstruction, solitary stones > 1 cm, duplex ureteral system, multiple arteries and veins Obesitas (BMI>35) / Comorbidity It is advisable to transplant the abnormal kidney leaving the donor with the best one. Relative contraindications Mireia Musquera Felip, Lluís Peri Cusí, Surgical aspects of living-donor kidney transplantation Nefrologia 2010;30(Suppl. 2):71-9 doi:10.3265/Nefrologia.pre2010.Nov.10693

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Vascular Anatomy

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Renal Vascular Pedicle Ronald A. Bergman, PhD Adel K. Afifi, MD, MS Multiple renal veins are rare on the left side 1 % while they are common on the right 27.8 %. single renal artery and vein in 59.5 %

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55% early bifurcation 14% Dual arterial 8% Single major renal artery and 1 or more smaller accessory renal arteries Other configurations (not shown) occur in 16% , including aberrant origins of the renal arteries from other visceral vessels, iliac arteries, and aortic bifurcation (modified from Uflacker R. Atlas of Vascular Anatomy, 2nd edition. Philadelphia, Pennsylvania: Lippincott, Williams, and Wilkins, 2007:609). 3%

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In living donor kidney transplantation (LDKT), the presence of anatomic variations of the donor renal vessels may constitute a relative contraindication, particularly for LLDN. The aim of our study was to review our results of LDKT when such anatomical variations were present. Introduction

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LDKT performed since 2004 were reviewed. Analyse the incidence and the type of anatomic variations of the donor renal vessels in Erasme Hospital. The techniques used for vascular reconstruction. Graft outcomes in normal donor vascular anatomy vs “abnormal” donor vascular anatomy groups. Methods Hopital Erasme Service Andominal Surgery and Transplantation Rout de Lennike 808, 1070 Brussels Belgium

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Imaging tests

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The reason for right donor nephrectomy Left

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Resalts Laparoscopic donor trans-peritoneal nephrectomy N = 54

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Vein reconstruction 16,6% (N=9) Results

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One orthotopic left kidney was performed. Artery reconstraction 36% (N=20) Results VS

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Reconstruction of the 4 renal arteries Reconstruction of the polar artery Reconstruction of the kidney vien using gonadic vein of the donor Reconstruction of the 2 renal arteries

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Anatomic variations of the donor renal vessels are frequent. Adequate surgical management, vascular reconstruction, allows obtaining similar results than those observed in case of normal anatomy and increases the donor pool. Conclusion Laparoscopic assisted living donor right nephrectomy with reconstruction of vascular access in the case of multiple arteries or short vein has no disadvantages compare with left living donor nephrectomy. Use of the anatomical donor’s material during living donor kidney transplantation can be permitted by transperitoneal laparoscopic assisted nephrectomy.