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Renal Transplantation: Surgical Technique

  • Chapter
Abdominal Solid Organ Transplantation

Abstract

The principles of the vascular anastomosis technique proposed by Carrel in 1902 and the accomplishment of the implantation in the iliac vessels by Kuss in 1951 are still in use. During renal transplantation the standard vein anastomosis technique is an end-to-side anastomosis performed between the graft renal vein and the recipient’s external iliac vein with an extraperitoneal approach. For arterial anastomosis end-to-side anastomosis to the external iliac artery is the preferred technique in deceased donors. The extravesical ureteroneocystostomy was first described by Witzel in 1896 and was popularized by Lich. Herein called the Lich-Gregoir, it is characterized by extravesicular access, the formation of an antireflux tunnel, and a urothelial anastomosis. Double kidney transplantation (DKT) is another approach for expansion of the existing deceased donor pool. Transplantation of two marginal kidneys rather than one suboptimal kidney to one recipient would result in more functioning nephrons that ultimately may improve the patient and graft outcome.

High-risk marginal kidneys are considered those from donors aged >70 years or 60–69 years with at least two of the following conditions: serum creatinine >1.5 mg/dL, calculated creatinine clearance <60 ml/min, history of hypertension or diabetes, proteinuria >1 g/day, and cause of death is cerebrovascular. High-risk donors are subjected to a renal biopsy, and, based on the Karpinski and Remuzzi histological scores, the kidneys are allocated for single kidney transplantation (SKT) or DKT.

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Author information

Authors and Affiliations

  1. Division of General and Transplant Surgery, University of Bologna, Via Massarenti 9, Bologna, 40138, Italy

    Massimo Del Gaudio MD, PhD, Annalisa Amaduzzi MD, Flavia Neri MD & Matteo Ravaioli MD, PhD

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  1. Massimo Del Gaudio MD, PhD
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  2. Annalisa Amaduzzi MD
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  3. Flavia Neri MD
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  4. Matteo Ravaioli MD, PhD
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Correspondence to Massimo Del Gaudio MD, PhD .

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Editors and Affiliations

  1. Surgery and Transplantation, Sant'Orsola Malpighi Hospital, Bologna, Bologna, Italy

    Antonio Daniele Pinna

  2. Surgery and Transplantation, Sant'Orsola Malpighi Hospital, Bologna, Bologna, Italy

    Giorgio Ercolani

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Del Gaudio, M., Amaduzzi, A., Neri, F., Ravaioli, M. (2015). Renal Transplantation: Surgical Technique. In: Pinna, A., Ercolani, G. (eds) Abdominal Solid Organ Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-16997-2_19

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  • DOI: https://doi.org/10.1007/978-3-319-16997-2_19

  • Publisher Name: Springer, Cham

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