3D-Printed Cold Preservation Device in Renal Autotransplantation for the Treatment of a Patient With Renal Artery Stenosis

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.

Comment on renal autotransplantation: A final option to preserve the kidney after an iatrogenic ureteral injury

To the Editor, Autologous Renal Transplantation (ART) since firstly described in 1963 by Hardy, has been used in various cases. There are various reasons for the transplantation such as iatrogenic ureteral damage, chronic kidney pain, unresectable renal tumors or renovascular diseases. Indications concerning the suitable patients for this kind of procedure are gradually increasing. Nevertheless, each case is unique, and the treatment must be personalized [...].

EP.TH.112The Use Ex-Vivo Renal Autotransplantation to Treat Hypertension Secondary to Renal Artery Disease: Two Case Reports

Renal Auto transplantation (RAT) is the surgical procedure in which the kidney is initially removed and subsequently re-implanted in a different position, allowing for improved outcomes in conditions involving ureteral pathology, renovascular and neoplastic disease primarily. In this paper, we aim to build upon the understanding of RAT and especially its effectiveness in treating patients with hypertension secondary to renal artery disease, intolerant to previous treatment approaches. In particular, the ex-vivo technique will be focused upon as introduced by Ota et al. in 1967 whereby the use of the workbench is frequently applied for patients requiring in excess of 45 minutes of ischaemic time. We, therefore, put forth two cases managed in co-operation by the University of Arkansas vascular and urology departments. The first of which was a 52-year-old woman with an aneurysmal Lesion reaching the renal artery at the hilum. The second was an 18-year-old woman with Takayasu arteritis. The use of vasopressin had preserved some renal function however at the time of the diagnosis, they were experiencing difficulty in controlling their hypertension, and thus RAT was performed, and the subsequent patient postoperative outcomes and effectiveness have been recorded and analysed as part of this study.

Nutcracker syndrome - a mini review on current knowledge

Nutcracker syndrome (NCS) seems to be an under-diagnosed condition defined as external compression of the left renal vein and consequent blood outflow impairment. The majority of cases involve the left renal vein entrapment between abdominal aorta and the superior mesenteric artery. The exact epidemiology is unknown due to lack of consensus on diagnostic criteria and often asymptomatic courses. NCS may occur at any age with peak presentation in the second and third decade of life. There is a slight prevalence in females. The most frequent presentations include micro and macroscopic hematuria, orthostatic proteinuria, orthostatic hypotension, flank pain. Patients may develop pelvic congestion syndrome comprising dyspareunia, dysmenorrhea, abdominal pain, pelvic, gluteal, vulvar varicose veins and varicocele in men. Clinical suspicion of NCS based on signs and symptoms, requires imaging confirmation utilising modalities such as doppler ultrasonography, computed tomography and magnetic resonance angiography, intravascular ultrasound and phlebography. Treatment options of NCS range from conservative surveillance to nephrectomy, thus appropriate approach should be based on clinical manifestation and severity of symptoms. Patients presenting with mild to moderate haematuria, and acceptable symptoms should be treated conservatively. In cases of severe symptoms or when conservative management fails, invasive treatment should be considered. Recommended open surgical procedures include left renal vein distal transposition and renal autotransplantation. Endovascular stenting approach seems to be an encouraging solution. Further long term follow-up is required to create objective treatment guidelines.

Surgical management in retroperitoneal fibrosis: beyond ureterolysis

Background Retroperitoneal fibrosis can be associated with bilateral dense and extensive periureteral adhesions. When ureterolysis could not be successfully performed due to disease extent and severity, elaborate ureteral reconstructive procedures will be required. Case presentation A young male with retroperitoneal fibrosis presented with bilateral hydroureteronephrosis. The ureteral involvement was extensive and adhesions were dense. He was managed by laparoscopic boari flap ureteroneocystostomy on one renal unit and laparoscopic nephrectomy with renal autotransplantation on the other renal unit. Conclusions Ureterolysis is not feasible in all cases of retroperitoneal fibrosis. Extensive bilateral ureteral reconstruction without using intestinal segments is feasible. Minimally invasive surgical reconstructive procedures can be successfully employed in such scenarios also.

Kidney Autotransplantation for Treatment of Ureteric Obstruction: A Case Report and Brief Review of the Literature

Autologous kidney transplantation is a relatively rare procedure that has been used as an alternative treatment for a variety of complex genitourinary problems, in particular for the treatment of complex proximal ureteral strictures. In this case report, a 47-year-old male, who had undergone a living donor nephrectomy 14 years earlier, presented with episodes of acute kidney injury on chronic kidney disease. He was found to have a complex proximal ureter stricture of his solitary right kidney. He underwent nephrectomy with subsequent autotransplantation of the kidney into the right iliac fossa. His renal function improved significantly after surgery. Renal autotransplantation may be considered for the management of proximal ureteral obstruction when alternative options are contraindicated.

Renal autotransplantation – reappraisal of an old technique

Objective Transplantation of the patient’s own kidney into the iliac fossa has been described already more than 50 years ago, predominately for the treatment of renal trauma or peripheral renal artery aneurysms. The technique is however rarely used. We describe our experience with renal autotransplantation. Methods Retrospective analysis of consecutive patients. Results We performed renal autotransplantation in 3 patients from 2017-2019. The first patient was a 72y old male who had previously multiple stents placed in both renal arteries for renal artery stenosis and presented with a high grade in-stent stenosis of the right renal artery, complete occlusion of the left renal artery and left renal atrophy. The second patient was a 56y old male who presented with a 29mm aneurysm in the bifurcation of the left renal artery. The third patient was a 29y female with Takayasu disease, who had undergone endarterectomy of the abdominal aorta and vein bypass to the left renal artery as a child and stenting of the abdominal aorta for restenosis. She presented with aneurysmatic dilatation and high-grade restenosis of the vein bypass to the left renal artery. In the first two patients, laparoscopic nephrectomy via a retroperitoneal approach was performed as for living donor nephrectomy. The patient with the renal artery aneurysm had back table resection of the aneurysm and reconstruction by forming a common ostium of the two branch arteries. In the third patient, we explanted the kidney via laparotomy. In all patients, the kidney was perfused with cooled organ preservation solution after a brief period of warm ischemia and transplanted in the iliac fossa in standard fashion. After a median follow-up of 20 months (range 9-31) all autotransplanted kidneys showed good perfusion with no signs of renal artery stenosis. Median creatinine clearance was 97ml/min/1.7m2 (range 59-118). Conclusion Renal autotransplantation is a safe and durable procedure worth remembering when evaluating the treatment options of complex renal artery pathologies. Its use can also be envisaged for the treatment of complex renal trauma or complex ureter lesions.