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Lin S, Gai J, Huang S, He Y, Hao D, Luo S, Lin Y, Qiu J, Li J, Wang C, Wu C. Clinical advances in kidney autotransplantation: a review. BMC Surg 2025; 25:54. [PMID: 39910519 PMCID: PMC11796257 DOI: 10.1186/s12893-024-02754-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 12/30/2024] [Indexed: 02/07/2025] Open
Abstract
Kidney autotransplantation is a surgical procedure with multiple indications and advancing technological approaches. Kidney autotransplantation is used to address complex kidney-related diseases including renal vascular lesions, ureteral diseases, tumors, loin pain-hematuria syndrome, and conditions affecting a solitary kidney or both kidneys. Renal artery lesions, including aneurysms and stenoses, often necessitate kidney autotransplantation in cases involving renal artery bifurcation or distant failure of endovascular repair. Complex ureteral lesions such as ureteral avulsions are commonly treated with kidney autotransplantation. Renal tumors, especially centrally located tumors or those involving the renal hilum, are treated using this technique while preserving renal function. It is worth emphasizing that this would be a rarely used last-resort technique in the modern era of minimally invasive nephron-sparing surgery. Kidney autotransplantation may be indicated for the rare condition of loin pain-hematuria syndrome when conservative measures fail. Additionally, individuals with solitary or bilateral kidney disease benefit from kidney autotransplantation to preserve their renal function. Traditional open-kidney autotransplantation involves renal extraction, workbench repair, and renal reimplantation. Technological advancements have introduced minimally invasive techniques including laparoscopic- and robot-assisted kidney autotransplantation, which reduce surgical trauma and recovery times. These techniques have shown promising outcomes, and robotic platforms have the potential to further reduce complications. In this study, we reviewed diverse indications and recent technological innovations in the field of kidney autotransplantation.
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Affiliation(s)
- Shengjie Lin
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
- School of Medicine, Xiamen University, Xiamen, 361100, China
| | - Jingci Gai
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Shangjin Huang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yingzhen He
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Da Hao
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Shuhang Luo
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yilong Lin
- School of Medicine, Xiamen University, Xiamen, 361100, China
| | - Jiang Qiu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
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Han DS, Johnson JP, Schulster ML, Shah O. Indications for and results of renal autotransplantation. Curr Opin Nephrol Hypertens 2023; 32:183-192. [PMID: 36683544 DOI: 10.1097/mnh.0000000000000860] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW To understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. RECENT FINDINGS Renal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) - though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists. SUMMARY In experienced hands, renal autotransplantation is a reasonable treatment approach for complex and refractory renal vascular disease, Loin-Pain Hematuria Syndrome, ureteral strictures and trauma, upper urinary tract malignancy, and stone disease in highly select patients.
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Affiliation(s)
- David S Han
- Columbia University Irving Medical Center, Department of Urology
| | - Jeffrey P Johnson
- Weill Cornell Medical College, Department of Urology, New York, New York, USA
| | | | - Ojas Shah
- Columbia University Irving Medical Center, Department of Urology
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Cui D, Wu B, He D, Wang Y, Jiao Y, Zhang B. 3D-Printed Cold Preservation Device in Renal Autotransplantation for the Treatment of a Patient With Renal Artery Stenosis. Front Bioeng Biotechnol 2022; 9:738434. [PMID: 35047485 PMCID: PMC8762299 DOI: 10.3389/fbioe.2021.738434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022] Open
Abstract
Percutaneous transluminal angioplasty (PTRA) is a common treatment method for renal vascular disease (RVD). However, PTRA may not be effective in patients with abnormal vascular disease. Renal autotransplantation (RAT) has been used as an alternative therapy for these diseases. Restrictions due to intracorporeal kidney cold preservation and the renal function of intracorporeal RAT were not as well protected compared with open operation. We developed this technique of 3D-printed polylactide (PLA) cold jackets for laparoscopic complete intracorporeal RAT for the purpose of better protecting the renal function and determining the feasibility of this novel procedure. The procedure was successfully applied to a 51-year-old woman with bilateral renal artery stenosis. The operation time was 5 hours, and blood loss was 200 ml. The patient’s blood pressure remained constant throughout the operation, and the pressure was maintained at 120-140/70–90 mmHg without antihypertensive drugs 1 week after the operation. B-ultrasound showed that the blood flow signal of the transplanted kidney was normal and the boundary between the skin and medulla was clear. The patient was discharged 2 weeks after surgery. One year postoperatively, Doppler ultrasound of the autotransplant showed that the transplanted kidney was normal in size and shape. Radionuclide renal dynamic imaging revealed that the glomerular filtration rate (GFR) of the transplanted kidney was 36.9 ml/min. 3D-printed polylactide (PLA) cold jackets for laparoscopic complete intracorporeal RAT are a safe and effective method for the treatment of renal artery stenosis and represent a feasible method for preserving the renal function of severe renal artery stenosis patients; however, the technology is still at the exploratory stage and has room for further improvements.
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Affiliation(s)
- Dong Cui
- Department of Urology, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Bin Wu
- Department of Urology, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Dali He
- Department of Urology, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yanen Wang
- Industry Engineering Department, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, China
| | - Yong Jiao
- Department of Urology, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Bo Zhang
- Department of Urology, Tangdu Hospital, The Air Force Medical University, Xi'an, China
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Renal Artery Surgery: The Struggle for Technical Advances and Durable Outcomes. Eur J Vasc Endovasc Surg 2018; 57:569. [PMID: 30509889 DOI: 10.1016/j.ejvs.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/13/2018] [Indexed: 11/22/2022]
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Chavent B, Barral X. Renovascular hypertension: results in adulthood of renal autotransplantation performed in children-response to comments by Della Schiava and Lermusiaux. Pediatr Nephrol 2017; 32:1995. [PMID: 28695308 DOI: 10.1007/s00467-017-3724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Bertrand Chavent
- Cardiovascular Surgery Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France.
| | - Xavier Barral
- Cardiovascular Surgery Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France
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