title: Long-Term Follow-up After Right Laparoscopic Donor Nephrectomy and Inverted Kidney Transplant.
abstract: OBJECTIVE
  The objective of this study was to investigate the long-term outcomes of inverted kidney transplant, an alternative easy and safe technique to overcome difficulties associated with short right renal vein anastomosis after laparoscopic donor nephrectomy.
  
  
  METHODS
  Seventy-nine laparoscopic donor nephrectomies and intentionally inverted renal transplants were performed between 2004 and 2009. For these transplants, the renal artery was ligated by Hem-o-lok (Weck Surgical Instruments, Teleflex Medical, Durham, NC, USA) and titanium clips, and the vein was closed with 2 Hem-o-lok clips, resulting in a short renal vein. By inverting the recovered kidney to the ipsilateral pelvic side of he recipient, the short renal vein is placed posterior and adjacent to the external iliac vein; this made an easy and safe short renal vein anastomosis possible.
  
  
  RESULTS
  All donor nephrectomies were completed laparoscopically, and no conversion to open surgery was required. The mean warm and cold ischemic times were 7.3 minutes (range, 3.2-17.5 min) and 37.5 minutes (range, 14.2-88 min). Only 6 patients (7.6%) had delayed graft function. At 5 years after transplant, patients showed excellent graft function, with mean serum creatinine level of 1.46 mg/dL and graft survival of 93.7%. There were no occurrences of vascular thrombosis or acute rejection. However, 5 years after transplant, 4 patients had died, with 3 patients still having functional transplanted kidneys and 1 patient experiencing graft rejection 1 month before death.
  
  
  CONCLUSIONS
  Inverted kidney transplant is an easy and safe method to overcome the complications associated with short right renal vein anastomosis after laparoscopic donor nephrectomy. This simple modification might obviate the need to elongate a short renal vein.
authors: From the Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Nasser
authors: N
authors: Simforoosh
authors: Ali
authors: A
authors: Tabibi
authors: Mohammad Hossein
authors: MH
authors: Soltani
authors: Samad
authors: S
authors: Zare
authors: Seyed Reza
authors: SR
authors: Yahyazadeh
authors: Behrang
authors: B
authors: Abadpoor
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D050377:Cold Ischemia; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects; D011446:Prospective Studies; D012077:Renal Artery / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D052096:Warm Ischemia; D055815:Young Adult