Donor horseshoe kidneys for transplantation

En Bloc Transplantation of Horseshoe Kidney from Deceased Donor: An Unusual Transplantation Utilizing Kidneys with Congenital Fusion Abnormality

Transplanting horseshoe kidneys is challenging and has higher complication rates due to the unusual anatomy of the vascular and urinary collecting systems. Most centers avoid using these kidneys for transplantation. However, if chosen carefully, these organs can be used successfully to reduce organ shortage. In this paper, we will describe the technique of procurement of horseshoe kidneys from cadaveric donors, back table preparation, and its successful implantation in a recipient. With good planning and skillful surgical techniques, horseshoe kidneys can be successfully transplanted in suitable recipients. If properly selected, these kidneys can be used to reduce the organ scarcity and diminish waitlist morbidity and mortality.

Horseshoe kidney transplantation

Horseshoe kidney is a fusion anomaly found in approximately one in 400-600 people. Due to vascular and ureteral variations, transplantation with a horseshoe kidney presents a technical challenge. In our case, the isthmus connected the upper poles and contained parenchyma. It consisted of three renal arteries, five veins collected to the inferior vena cava, and two ureters and pyelons. It was implanted en bloc to the left side retroperitoneally. During the early period, cellular and humoral rejection was confirmed and treated. For a urine leak, double J catheters were implanted into both ureters. Later, the first catheter was removed. Subsequently, urinary sepsis developed, necessitating graftectomy. The uncommon anatomy of ureters and antibody-mediated rejection (AMR) may both be factors for a ureter tip necrosis led to an infected urinoma. After other Hungarian authors, we also report a horseshoe kidney transplantation that was technically successful. However, after an adequately treated but severe acute humoral rejection, the patient developed sepsis, and the kidney had to be removed. We conclude that transplantation with horseshoe kidney is technically feasible but may increase the risk for urinary complications and resultant infections. Careful consideration of risk and benefit is advised when a transplant professional is faced with this option.

Segmental Renal Ischemia following Transplantation of Horseshoe Kidney as Separate Allografts

Introduction. Horseshoe kidney is a congenital anomaly that presents unique challenges for the transplant surgeon. The mere presence of horseshoe kidney should not preclude consideration for transplantation. Case Report. A 33-year-old women suffering from end-stage renal disease underwent deceased donor renal transplant with a divided horseshoe kidney. We present a postoperative complication and the technical strategy for transplant salvage. The patient currently has excellent graft function. Discussion. Horseshoe kidneys do present challenges for successful transplantation. Though case reports of successful transplantation are increasing, we present a technical complication and successful transplant salvage strategy. Technical descriptions in the literature of successful back-table preparation strategies should help more transplant surgeons to begin to utilize this resource. Conclusion. This study concludes that horseshoe kidneys can be successfully used for transplantation and provides a technical strategy to salvage the transplant after a unique complication associated with these donor kidneys.

Aortic Extension for En Bloc Transplantation of Horseshoe Kidneys

INTRODUCTION

We report a technique for extending the distal aorta to facilitate the transplantation of en bloc horseshoe kidneys.

TECHNICAL CONSIDERATIONS

En bloc horseshoe kidneys can be transplanted by a technique that is analogous to the en bloc transplantation of small pediatric kidneys. However, the horseshoe kidney's isthmus prevents ascent of the kidney, and the fused lower poles stay below the level of the inferior mesenteric artery. Therefore, the distal aorta is behind the isthmus. Extending the distal aorta produces adequate vessel length to simplify en bloc transplantation of horseshoe kidneys. The extra aortic length is obtained by spatulating the distal common iliac arteries on their medial surfaces and bringing them together as a "pair of pants" for about 1.5 cm. This produces an arterial conduit that branches into the left and right common iliac arteries and then rejoins at the distal aorta. The aortic extension produces a useable vascular conduit that can be anastomosed to the recipient's external iliac artery. The distal inferior vena cava is anastomosed to the external iliac vein. We used this technique in 1 patient. The transplanted kidney made urine promptly and was providing normal function with a serum creatinine of 1.1 mg/dL.

CONCLUSIONS

It is preferable to transplant some horseshoe kidneys en bloc using the distal aorta and inferior vena cava for vascular anastomoses. This technique extends the distal aorta and provides adequate vessel length to facilitate en bloc transplantation.