title: Strategies for transplantation of cadaveric kidneys with congenital fusion anomalies.
abstract: OBJECTIVE
  The dire shortage of cadaveric kidneys has led to a gradual expansion of donor criteria in the transplant community. The use of kidneys with anatomical fusion anomalies is uncommon and has not been well defined in the literature. We evaluated the surgical strategies and postoperative outcomes of transplanting cadaveric kidneys with congenital fusion anomalies.
  
  
  METHODS
  Three cadaveric kidneys with congenital fusion anomalies were procured and transplanted between May 1994 and November 1999. None of the 3 donors had any significant urological history. All fusion anomalies were identified during the organ procurement process.
  
  
  RESULTS
  Anomalies included 1 L-shaped cross-fused ectopic and 2 horseshoe kidneys. All 3 kidneys were procured en bloc. One horseshoe kidney with a narrow isthmus was split and the 2 kidneys were transplanted into separate recipients, while the other horseshoe kidney was transplanted en bloc into a single recipient. The L-shaped kidney was transplanted en bloc into 1 patient. All transplants were successful with a serum creatinine of 1.1 to 1.9 mg/dl.
  
  
  CONCLUSIONS
  To our knowledge we present the initial case of transplantation of an L-shaped kidney. Cadaveric kidneys with congenital fusion anomalies may be transplanted successfully using various individual technical strategies based on the specific renal anatomy. As such, these kidneys may be used to maximize the increasingly inadequate donor pool.
authors.affiliation: Section of Renal Transplantation, Department of Urology, Cleveland Clinic Foundation, Omaha, Nebraska,USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: T H
authors.initials: TH
authors.lastname: Hsu
authors.forename: D A
authors.initials: DA
authors.lastname: Goldfarb
authors.forename: R J
authors.initials: RJ
authors.lastname: Taylor
authors.forename: A C
authors.initials: AC
authors.lastname: Novick
authors.forename: I S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000465:Algorithms; D002102:Cadaver; D006801:Humans; D007668:Kidney / Q000002:abnormalities*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome