title: [Renal autotransplantation: a valid option in the resolution of complex cases].
abstract: OBJECTIVE
  To analyze the current indications for renal autotransplantation, as well as the technical features, complications and long-term follow-up of the technique.
  
  
  METHODS
  From 1990 to 2005 we have performed autotransplantation in 10 patients, 7 adults and 3 children. The indication was established due to vascular pedicle pathology in 8 cases and ureteral lesion in 2. The cause of vascular pathology was: atherosclerotic stenosis (4), dysplastic stenosis (2), Takayasu's disease stenosis (1), and renal artery aneurysm (1). The patients with ureteral lesion had ureteral stenosis secondary to Crohn's disease in one case, initially solved by ureteral stent and subsequently obstructed by lithiasic encrustation, and ureteral avulsion in the other case. The vascular grafts employed in the 8 cases with vascular reconstruction were: hypogastric artery 7 cases, and sophena vein in one case. Ureteral reimplantation was necessary in 5 cases after bench surgery; in other five cases vascular reconstruction was performed without ureteral division. All grafts were perfused with 4 degrees C lactate ringer or Wisconsin solution and protected with surface cold ischemia. Ischemia times ranged from 42 to 89 minutes.
  
  
  RESULTS
  Nine kidneys (90%) functioned after autotransplantation, 8 of them had immediate function, and one had delayed graft function after a six-day period of acute tubular necrosis. The kidney with arterial stenosis secondary to Takayasu's disease never functioned. The cause of graft loss was renal vein thrombosis. Postoperative mortality was zero. After a mean follow-up of 72+/- 13 months mean serum creatinine is 1.6+- 0.4 mg/dl (1.1-2.4) and 70% (7/10) of the patients have normal blood pressure without antihypertensive medication.
  
  
  CONCLUSIONS
  Currently, renal autotransplantation, with or without extracorporeal vascular reconstruction, is a complex technique with exceptional indications, but it allows recovering renal units with vascular pathology not amenable to angioplasty or in situ revascularization. It is also a valid alternative to ileal ureteral substitution in cases of extensive ureteral lesion.
authors.affiliation: Servicio de Urología Ramón y Cajal, Madrid. España. llfando@hotmail.com
authors.forename: Luis
authors.initials: L
authors.lastname: López-Fando Lavalle
authors.forename: Javier
authors.initials: J
authors.lastname: Burgos Revilla
authors.forename: Javier
authors.initials: J
authors.lastname: Sáenz Medina
authors.forename: Ana
authors.initials: A
authors.lastname: Linares Quevedo
authors.forename: Jorge
authors.initials: J
authors.lastname: Vallejo Herrador
authors.forename: Cristina
authors.initials: C
authors.lastname: De Castro Guerin
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual Santos
authors.forename: Roberto
authors.initials: R
authors.lastname: Marcén Letosa
mesh_terms: D000328:Adult; D002648:Child; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors