title: Transposition of iliac vessels in implantation of right living donor kidneys.
abstract: BACKGROUND
  The rate of right laparoscopic living-donor nephrectomy (RLLDN) is low among kidney transplantations due to the short renal vein and presumed higher risk of thrombosis. Our objective was to describe a surgical technique to compensate for the shorter veins of these grafts.
  
  
  METHODS
  Between January 2004 and July 2010, we prospectively collected data from all transplantations using RLLDN-harvested kidneys at our center. Recipient iliac vein transposition was performed in all patients. We reviewed the indications, surgical techniques, and postoperative courses.
  
  
  RESULTS
  The 43 included cases showed a 2.1 +/- 0.6 cm, average length of the right renal vein as measured on abdominal computed tomography (CT). The mean extraction and implantation times were 109 +/- 33 and 124 +/- 31 minutes, respectively; the mean warm ischemia time was 151 +/- 29 seconds. Two recipients required postsurgical blood transfusions. In 97.6% of cases, there was immediate urine flow. Postoperative echo-Doppler revealed good arterial and venous flows in all patients. No venous thromboses were detected. The recipients' average hospital stay was 8 +/- 5 days. With a mean follow-up of 57 months, 86% of recipients maintain a glomerular filtration rate (GFR) >50 mL/min and creatinine levels <1.5 mg/dL.
  
  
  CONCLUSIONS
  Transposition of the recipient iliac vein during implantation is a good technical solution to compensate for the short length of the right renal vein. The use of iliac vein transposition allowed us to perform safe implants of RLLDN-harvested kidneys with good short-term and long-term results.
authors.affiliation: Urology Department, Hospital Clinic of Barcelona, Barcelona, Spain. alexciudin@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Ciudin
authors.forename: M
authors.initials: M
authors.lastname: Musquera
authors.forename: J
authors.initials: J
authors.lastname: Huguet
authors.forename: L
authors.initials: L
authors.lastname: Peri
authors.forename: J R
authors.initials: JR
authors.lastname: Alvarez-Vijande
authors.forename: M J
authors.initials: MJ
authors.lastname: Ribal
authors.forename: A
authors.initials: A
authors.lastname: Alcaraz
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010690:Phlebography / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D052096:Warm Ischemia
chemical_list: D015415:Biomarkers; D003404:Creatinine