title: Renal Autotransplantation: 27-Year Experience at 2 Institutions.
abstract: OBJECTIVE
  Renal autotransplantation is an infrequently performed procedure. It has been used to manage complex ureteral disease, vascular anomalies and chronic kidney pain. We reviewed our 27-year experience with this procedure.
  
  
  METHODS
  This is a retrospective, observational study of 51 consecutive patients who underwent renal autotransplantation, including 29 at Oregon Health and Science University between 1986 and 2013, and 22 at Virginia Mason Medical Center between 2007 and 2012. Demographics, indications, operative details and followup data were collected. Early (30 days or less) and late (greater than 30 days) complications were graded according to the Clavien-Dindo system. Factors associated with complications and pain recurrence were evaluated using a logistic regression model.
  
  
  RESULTS
  The 51 patients underwent a total of 54 renal autotransplants. Median followup was 21.5 months. The most common indications were loin pain hematuria syndrome/chronic kidney pain in 31.5% of cases, ureteral stricture in 20.4% and vascular anomalies in 18.5%. Autotransplantation of a solitary kidney was performed in 5 patients. Laparoscopic nephrectomy was performed in 23.5% of cases. Median operative time was 402 minutes and median length of stay was 6 days. No significant difference was found between preoperative and postoperative plasma creatinine (p = 0.74). Early, high grade complications (grade IIIa or greater) developed in 14.8% of patients and 12.9% experienced late complications of any grade. Two graft losses occurred. Longer cold ischemia time was associated with complications (p = 0.049). Of patients who underwent autotransplantation for chronic kidney pain 35% experienced recurrence and 2 underwent transplant nephrectomy. No predictors of pain recurrence were identified.
  
  
  CONCLUSIONS
  The most common indications for renal autotransplantation were loin pain hematuria syndrome/chronic kidney pain, ureteral stricture and vascular anomalies in descending order. Kidney function was preserved postoperatively and 2 graft losses occurred. At a median followup of 13 months pain resolved in 65% of patients who underwent the procedure. Complication rates compared favorably with those of other major urological operations and cold ischemia time was the only predictor of postoperative complications.
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland.
authors.forename: Nick G
authors.initials: NG
authors.lastname: Cowan
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: John S
authors.initials: JS
authors.lastname: Banerji
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Johnston
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Duty
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Bakken
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland. Electronic address: hedgesja@ohsu.edu.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Hedges
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kozlowski
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Hefty
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland.
authors.forename: John M
authors.initials: JM
authors.lastname: Barry
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous; D014481:United States / Q000453:epidemiology
keywords: autografts; hematuria; kidney transplantation; pain; ureteral stricture