title: Indication, surgical technique and outcome of orthotopic renal transplantation.
abstract: OBJECTIVE
  We review the indication, surgical technique and outcome of orthotopic renal transplantation.
  
  
  METHODS
  The medical records of 1,000 patients who underwent renal transplantation at our institution between August 24, 1993 and August 1, 2000, as well as orthotopic renal transplantation were reviewed.
  
  
  RESULTS
  Orthotopic renal transplantation was performed in 4 males and 1 female with severe iliac atherosclerosis or retained bilateral iliac fossa kidney transplant. Mean patient age was 56 years. There were 2 patients who received kidneys from living related donors, and 3 underwent cadaveric renal transplantation. Left orthotopic renal transplantation was successful in 4 cases, and 1 was converted to iliac fossa renal transplant because of a pulseless splenic artery and renal artery thrombosis after native renal endarterectomy. Orthotopic renal revascularization was done with splenic artery in 2, native renal artery in 2 and left renal vein in all 4 patients. Urinary tract reconstruction was performed with stented (2) or nonstented (2) ureteroureterostomy. Antibody induction, purine antagonists, calcineurin inhibitors and glucocorticoids were used for immunosuppression. Mean preoperative and 1-month postoperative serum creatinine was 7.9 and 1.3 mg./dl., respectively. Patient and graft survival was 100% during followup, which ranged from 6 months to 5 years.
  
  
  CONCLUSIONS
  Despite the technical challenges, orthotopic renal transplantation in patients with unsuitable pelvic vessels can result in excellent patient and graft survival.
authors.affiliation: Division of Urology and Renal Transplantation, Oregon Health Sciences University, Portland, Oregon, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Paduch
authors.forename: J M
authors.initials: JM
authors.lastname: Barry
authors.forename: A
authors.initials: A
authors.lastname: Arsanjani
authors.forename: M J
authors.initials: MJ
authors.lastname: Lemmers
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies