Alternative grafting technique for patients unsuited to heterotopic transplantation due to diseased pelvic conditions.
BACKGROUND
An alternative technique for kidney transplantation is presented for patients in whom the use of pelvic vessels is precluded.


METHODS
Of 482 cases of kidney or pancreas-kidney transplants, 4 were unsuited to heterotopic grafting, 1 due to multiple operations in the fossae and the 3 others due to extensive vascular occlusive disease. The patients were studied preoperatively by magnetic resonance angiography, which revealed extensive occlusive disease of the distal aorta and/or iliac vessels.


RESULTS
The patients received kidneys from living related donors as a third or second transplant opportunity in the orthotopic position (2 cases). Gross dissection of the aorta revealed a thickened wall, impeding direct anastomoses between the recipient's arteries and the donated organ. After a termino-lateral Dacron graft to the aorta, all cases were stented for uretero-uretero anastomosis. Recovery with respect to the renal graft was uneventful for all cases.


CONCLUSIONS
Alternative direct grafting from the aorta represents a viable and easy way to perform kidney transplants in patients unsuited to the heterotopic approach.
Rodrigues
Paulo
P
Section of Urology and Vascular Surgery, Hospital Beneficência Portuguesa, São Paulo, Brazil. paulortrodrigues@aol.com
D'Império
Márcio
M
Campagnari
Mariana
M
Azevedo
Luís A R
LA
Campagnari
João C
JC
van Bellen
Bonno
B
D000328:Adult; D001012:Aorta, Abdominal / Q000601:surgery*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D012307:Risk Factors