Salvage of compromised renal vessels in kidney transplantation using third-party cadaveric extenders: impact on posttransplant anti-HLA antibody formation.
Kidney transplant surgery can be complicated by short, attenuated, or injured renal vessels which are now more frequently encountered with laparoscopic right donor nephrectomy. We describe a technique to overcome this problem in seven recipients (2 cadaveric and 5 living donors) by constructing third-party "vascular extenders" using cadaveric iliac vessels retrieved previously and preserved at 4 degrees C in University of Wisconsin solution. Mean vessel cold storage time was 25.7 days (range, 2-56 days). Immunosuppression consisted of sirolimus, mycophenolate mofetil, and steroids. Prompt reperfusion of all allografts was observed, and there were no surgical complications. Integrity of the extenders was confirmed using serial MAG3 renal scans and magnetic resonance angiography. Mean serum creatinine was 1.44 mg/dl at 19.2 months (range, 0.7-2 mg/dl at 3-31 months). Each recipient had a negative posttransplant kidney donor specific flow cytometry crossmatch. Two recipients developed HLA antibodies, one to DR7 and another DR13 (mismatched to the vessel donor) at 4 and 11 months posttransplant, respectively.
Goel
Mahesh C
MC
Transplant Center, Glickman Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Flechner
Stuart M
SM
El-Jack
Mohammed
M
Veniro
John
J
Kingman
Lynne
L
Modlin
Charles
C
Cook
Daniel J
DJ
D000241:Adenosine; D000493:Allopurinol; D002102:Cadaver; D015925:Cryopreservation; D005978:Glutathione; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007328:Insulin; D016030:Kidney Transplantation / Q000379:methods*; D009392:Nephrectomy / Q000379:methods; D009926:Organ Preservation / Q000379:methods; D019188:Organ Preservation Solutions; D011887:Raffinose; D012077:Renal Artery / Q000637:transplantation; D012082:Renal Veins / Q000637:transplantation; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods
D007166:Immunosuppressive Agents; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose