title: Renal retransplantation after kidney and pancreas transplantation using the renal vessels of the failed allograft: pitfalls and pearls.
abstract: Renal retransplantation after a failed prior kidney and pancreas transplant is being increasingly performed. In these complex cases, both iliac fossae have been used for prior transplants, and the placement of the new allograft can be problematic. We describe our experience with an alternative technique for renal retransplantation (RRTx) in the setting of severe bilateral aortoiliac atherosclerosis or scarring and fibrosis on the iliac vessels. Nephrectomy of the failed allograft is performed, and the renal vessels of the failed allograft (RVFA) are preserved. The new kidney is implanted on RVFA at the same operative time. This technique was attempted and successfully accomplished in a total of six patients (mean operative time = 240 ± 63 min). One postoperative complication occurred: poor arterial inflow to the allograft, being corrected reoperatively. Hospitalizations ranged from five to eight d. Five of the six patients were alive with a functioning allograft at last follow-up (a single graft failure occurred 21 months postoperatively in the setting of post-transplant lymphoproliferative disease that also led to patient death). Renal vessels of the failed allograft seem to be suitable alternative vascular conduits for renal retransplantation after prior kidney and pancreas transplants.
authors.affiliation: Division of Transplantation Surgery, Department of Surgery and von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA.
authors.forename: Marcio F
authors.initials: MF
authors.lastname: Chedid
authors.forename: Manuel
authors.initials: M
authors.lastname: Moreno Gonzales
authors.forename: Suresh
authors.initials: S
authors.lastname: Raghavaiah
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Chauhan
authors.forename: Timucin
authors.initials: T
authors.lastname: Taner
authors.forename: Geir I
authors.initials: GI
authors.lastname: Nedredal
authors.forename: Walter D
authors.initials: WD
authors.lastname: Park
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D064591:Allografts; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016035:Pancreas Transplantation; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies
keywords: allograft nephrectomy; operative technique; renal retransplantation; renal vessels of the failed allograft; simultaneous pancreas and kidney transplantation