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Clin Transplant 2014: 28: 1303–1304 DOI: 10.1111/ctr.12467
Clinical Transplantation
Letter to the Editor
Right renal vein elongation using gonadal vein during retroperitoneoscopic living donor kidney transplantation: a single-center experience To the Editor, Here, we report our experience of eight cases of elongation of the right renal vein using donor gonadal vein during retroperitoneoscopic living donor kidney transplantation in our hospital. In living donor kidney transplantation, the left kidney is preferred as the right renal vein is shorter. Transplantation of the right kidney is technically more challenging for reimplantation of the graft due to higher venous anastomosis tension and also has a higher risk of complications. Elongation of the right renal vein is a key step in improvement of the success rate and reduction of operative complications of living donor nephrectomy. This report enrolled eight healthy donors, who were admitted between August 2013 and April 2014. Donors aged 45 9.5 yr old, including three men and five women. All donors were confirmed with single artery and vein in right kidney by MRI or CT 3-D vascular reconstruction. Donors and recipients were matched with satisfaction. All organ donations were on voluntary basis, and written informed consents were signed. The donor’s right kidney and gonadal vein were extracted through standard hand-assisted laparoscopic nephrectomy. The gonadal vein was cut longitudinally and trimmed into a patch of 6–8 cm long and 0.8–1.2 cm wide (Fig. 1). A 3- to 4-cm long vessel was formed by spiral anastomosis of the patch with a similar diameter as the right renal vein, which was then anastomosed with the renal vein (Fig. 2). Conventional kidney implantation surgery was performed. Patients were followed for six months. Color Doppler ultrasound test showed the blood flow was patent in vena profunda without renal vein related complications such as hemorrhage, thrombosis, or angusty, etc. All eight donor kidneys were successfully transplanted to recipients. The perioperative parameters for donor kidney nephrectomy are shown in
Fig. 1. A longitudinally incised gonadal vein.
Table 1. The right renal vein was elongated by an average of 2.9 cm. Donors had no obvious postoperative complications. Recipients’ creatinine levels all dropped to normal range within one wk post-operation, and good graft functions were observed. In the past years, a variety of techniques have been developed for lengthening of the right renal vein, which range from iliac vein transposition to donor vein elongation (1). For deceased donors, renal vein could be elongated with postcava (2). For living donors, the elongation material included linear cutting anastomat (3), polytetrafluoroethylene graft and a variety of veins, for example, the great saphenous vein (1). Mikhalski et al. (4) first reported lengthening the right renal vein with gonadal vein. We simultaneously extracted the donor’s right kidney and gonadal vein through retroperitoneoscopy and significantly increased the length of the right renal vein, which ultimately led to good organ function without increased peri- or postoperative morbidity during living donor kidney transplantation.
1303
Letter to the Editor
gonadal vein is safe and feasible and is worth wider clinical application. Authors’ contributions
This study was designed by and corresponded to Jian-tao Wang. Chun-hua Lin and Ke Wang performed data collection and analysis, as well as manuscript preparation. All authors participated in performing the operations. Chun-hua Lin*, Ke Wang*, Hui Wang, Jian-tao Wang, Qing-zuo Liu, Sheng-qiang Yu, Peng Zhang, Lei Shi and Zhen-li Gao Department of Urology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China e-mail: [email protected] Fig. 2. Extended right renal vein. (A) The anastomotic line between right renal vein and gonadal vein. (B) Elongated vein after spiral anastomosis.
References
Table 1. Perioperative parameters Index
Value
Gender (M/F, case) Age (yr) Operation time (min) Warm ischemia time (s) Intraoperative blood loss (mL) Average length of vein extension (cm) LOS (d) Follow-up time (month) Post-operative complication rate (%)
3/5 45 88.0 75.8 50.6 2.9 5.3 10 0
9.5 7.5 18.4 6.6 0.6 5.8
This study could be further improved by larger sample numbers and longer follow-up time. In general, we believe that renal vein elongation using
1304
*These two authors contributed equally to this study.
1. ALCOCER F, ZAZUETA E, MONTES DE OCA J. The superficial femoral vein: a valuable conduit for a short renal vein in kidney transplantation. Transplant Proc 2009: 41: 1963. 2. BAPTISTA-SILVA JC, MEDINA-PESTANA JO, VERISSIMO MJ, CASTRO MJ, DEMUNER MS, SIGNORELLI MF. Right renal vein elongation with the inferior vena cava for cadaveric kidney transplants. An old neglected surgical approach. Int Braz J Urol 2005: 31: 519. 3. BOLLENS R, MIKHASKI D, ESPINOZA BP et al. Laparoscopic live donor right nephrectomy: a new technique to maximize the length of the renal vein using a modified Endo GIA stapler. Eur Urol 2006: 51: 1326. 4. MIKHALSKI D, HOANG AD, BOLLENS R, LAUREYS M, LOI P, DONCKIER V. Gonadal vein reconstruction for extension of the renal vein in living renal transplantation: two case reports. Transplant Proc 2007: 39: 2681.
Copyright of Clinical Transplantation is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Clin Transplant 2014: 28: 1303–1304 DOI: 10.1111/ctr.12467
Clinical Transplantation
Letter to the Editor
Right renal vein elongation using gonadal vein during retroperitoneoscopic living donor kidney transplantation: a single-center experience To the Editor, Here, we report our experience of eight cases of elongation of the right renal vein using donor gonadal vein during retroperitoneoscopic living donor kidney transplantation in our hospital. In living donor kidney transplantation, the left kidney is preferred as the right renal vein is shorter. Transplantation of the right kidney is technically more challenging for reimplantation of the graft due to higher venous anastomosis tension and also has a higher risk of complications. Elongation of the right renal vein is a key step in improvement of the success rate and reduction of operative complications of living donor nephrectomy. This report enrolled eight healthy donors, who were admitted between August 2013 and April 2014. Donors aged 45 9.5 yr old, including three men and five women. All donors were confirmed with single artery and vein in right kidney by MRI or CT 3-D vascular reconstruction. Donors and recipients were matched with satisfaction. All organ donations were on voluntary basis, and written informed consents were signed. The donor’s right kidney and gonadal vein were extracted through standard hand-assisted laparoscopic nephrectomy. The gonadal vein was cut longitudinally and trimmed into a patch of 6–8 cm long and 0.8–1.2 cm wide (Fig. 1). A 3- to 4-cm long vessel was formed by spiral anastomosis of the patch with a similar diameter as the right renal vein, which was then anastomosed with the renal vein (Fig. 2). Conventional kidney implantation surgery was performed. Patients were followed for six months. Color Doppler ultrasound test showed the blood flow was patent in vena profunda without renal vein related complications such as hemorrhage, thrombosis, or angusty, etc. All eight donor kidneys were successfully transplanted to recipients. The perioperative parameters for donor kidney nephrectomy are shown in
Fig. 1. A longitudinally incised gonadal vein.
Table 1. The right renal vein was elongated by an average of 2.9 cm. Donors had no obvious postoperative complications. Recipients’ creatinine levels all dropped to normal range within one wk post-operation, and good graft functions were observed. In the past years, a variety of techniques have been developed for lengthening of the right renal vein, which range from iliac vein transposition to donor vein elongation (1). For deceased donors, renal vein could be elongated with postcava (2). For living donors, the elongation material included linear cutting anastomat (3), polytetrafluoroethylene graft and a variety of veins, for example, the great saphenous vein (1). Mikhalski et al. (4) first reported lengthening the right renal vein with gonadal vein. We simultaneously extracted the donor’s right kidney and gonadal vein through retroperitoneoscopy and significantly increased the length of the right renal vein, which ultimately led to good organ function without increased peri- or postoperative morbidity during living donor kidney transplantation.
1303
Letter to the Editor
gonadal vein is safe and feasible and is worth wider clinical application. Authors’ contributions
This study was designed by and corresponded to Jian-tao Wang. Chun-hua Lin and Ke Wang performed data collection and analysis, as well as manuscript preparation. All authors participated in performing the operations. Chun-hua Lin*, Ke Wang*, Hui Wang, Jian-tao Wang, Qing-zuo Liu, Sheng-qiang Yu, Peng Zhang, Lei Shi and Zhen-li Gao Department of Urology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China e-mail: [email protected] Fig. 2. Extended right renal vein. (A) The anastomotic line between right renal vein and gonadal vein. (B) Elongated vein after spiral anastomosis.
References
Table 1. Perioperative parameters Index
Value
Gender (M/F, case) Age (yr) Operation time (min) Warm ischemia time (s) Intraoperative blood loss (mL) Average length of vein extension (cm) LOS (d) Follow-up time (month) Post-operative complication rate (%)
3/5 45 88.0 75.8 50.6 2.9 5.3 10 0
9.5 7.5 18.4 6.6 0.6 5.8
This study could be further improved by larger sample numbers and longer follow-up time. In general, we believe that renal vein elongation using
1304
*These two authors contributed equally to this study.
1. ALCOCER F, ZAZUETA E, MONTES DE OCA J. The superficial femoral vein: a valuable conduit for a short renal vein in kidney transplantation. Transplant Proc 2009: 41: 1963. 2. BAPTISTA-SILVA JC, MEDINA-PESTANA JO, VERISSIMO MJ, CASTRO MJ, DEMUNER MS, SIGNORELLI MF. Right renal vein elongation with the inferior vena cava for cadaveric kidney transplants. An old neglected surgical approach. Int Braz J Urol 2005: 31: 519. 3. BOLLENS R, MIKHASKI D, ESPINOZA BP et al. Laparoscopic live donor right nephrectomy: a new technique to maximize the length of the renal vein using a modified Endo GIA stapler. Eur Urol 2006: 51: 1326. 4. MIKHALSKI D, HOANG AD, BOLLENS R, LAUREYS M, LOI P, DONCKIER V. Gonadal vein reconstruction for extension of the renal vein in living renal transplantation: two case reports. Transplant Proc 2007: 39: 2681.
Copyright of Clinical Transplantation is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
