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Kidney Transplantation

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Procurement and Transplantation of Abdominal Organs in Clinical Practice

Part of the book series: In Clinical Practice ((ICP))

Abstract

Renal transplantation remains the optimal treatment for end stage renal disease. Compared with dialysis, it is associated with increased patient survival and better quality of life, and is cost effective. Kidney transplantation requires a multi-disciplinary approach in the pre-operative assessment and work-up of donors and recipients, and subsequent post-operative care. The classical surgical procedure for renal transplantation has changed little from the original pelvic operation originally described in 1951, but the surgical complexity however has been magnified by the increasing age of recipients, frequently with other comorbidities, and impetus to utilise kidneys from extended criteria donors, either as single or dual transplants. There have also been tremendous advances in the technical aspects of live-donation. This chapter details the surgical aspects of kidney donation and transplantation, including preparation of the graft, vessel reconstruction, urinary drainage and identification and management of post-donation and transplantation complications. It is hoped the reader is provided with a comprehensive account of the technical aspects of renal transplantation, with a description of variation in procedure based on anatomical aberrations. An overview of current practise with a look to the future is provided.

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Bibliography

  1. Klein AA, Lewis CJ, Madsen JC. Organ transplantation; a clinical guide: Cambridge University Press; 2011.

    Google Scholar 

  2. Libby P, Pober JS. Chronic rejection. Immunity. 2001;14(4):387–97.

    Article  CAS  PubMed  Google Scholar 

  3. Pascual M, Theruvath T, Kawai T, Tolkoff-Rubin N, Cosimi AB. Strategies to improve long-term outcomes after renal transplantation. N Engl J Med. 2002;346(8):580–90.

    Article  PubMed  Google Scholar 

  4. Heaphy EL, Poggio ED, Flechner SM, Goldfarb DA, Askar M, Fatica R, et al. Risk factors for retransplant kidney recipients: relisting and outcomes from patients’ primary transplant. Am J Transplant. 2014;14(6):1356–67.

    Article  CAS  PubMed  Google Scholar 

  5. Nankivell BJ, Borrows RJ, Fung CL, O’Connell PJ, Allen RD, Chapman JR. The natural history of chronic allograft nephropathy. N Engl J Med. 2003;349(24):2326–33.

    Article  CAS  PubMed  Google Scholar 

  6. Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, et al. Risk of end-stage renal disease following live kidney donation. JAMA. 2014;311(6):579–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mjoen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Oyen O, et al. Long-term risks for kidney donors. Kidney Int. 2014;86(1):162–7.

    Article  PubMed  Google Scholar 

  8. Matas AJ, Wadstrom J, Ibrahim HN. Kidney donation and risk of ESRD. JAMA. 2014;312(1):92–3.

    Article  CAS  PubMed  Google Scholar 

  9. Heimbach JK, Taler SJ, Prieto M, Cosio FG, Textor SC, Kudva YC, et al. Obesity in living kidney donors: clinical characteristics and outcomes in the era of laparoscopic donor nephrectomy. Am J Transplant. 2005;5(5):1057–64.

    Article  PubMed  Google Scholar 

  10. Kalantar-Zadeh K, Kopple JD. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144(9):701; author reply 701–2.

    Article  Google Scholar 

  11. Vivante A, Golan E, Tzur D, Leiba A, Tirosh A, Skorecki K, et al. Body mass index in 1.2 million adolescents and risk for end-stage renal disease. Arch Intern Med. 2012;172(21):1644–50.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yang A, Barman N, Chin E, Herron D, Arvelakis A, LaPointe Rudow D, et al. Robotic-assisted vs. laparoscopic donor nephrectomy: a retrospective comparison of perioperative course and postoperative outcome after 1 year. J Robot Surg. 2018;12(2):343–50.

    Article  PubMed  Google Scholar 

  13. Minnee RC, Bemelman WA, Maartense S, Bemelman FJ, Gouma DJ, Idu MM. Left or right kidney in hand-assisted donor nephrectomy? A randomized controlled trial. Transplantation. 2008;85(2):203–8.

    Article  PubMed  Google Scholar 

  14. Hsu TH, Su L, Ratner LE, Trock BJ, Kavoussi LR. Impact of renal artery multiplicity on outcomes of renal donors and recipients in laparoscopic donor nephrectomy. Urology. 2003;61(2):323–7.

    Article  PubMed  Google Scholar 

  15. Saidi R, Kawai T, Kennealey P, Tsouflas G, Elias N, Hertl M, et al. Living donor kidney transplantation with multiple arteries: recent increase in modern era of laparoscopic donor nephrectomy. Arch Surg. 2009;144(5):472–5.

    Article  PubMed  Google Scholar 

  16. Gerstenkorn C, Papalois VE, Thomusch O, Maxwell AP, Hakim N. Surgical management of multiple donor veins in renal transplantation. Int Surg. 2006;91(6):345–7.

    CAS  PubMed  Google Scholar 

  17. Tran MH, Foster CE, Kalantar-Zadeh K, Ichii H. Kidney transplantation in obese patients. World J Transplant. 2016;6(1):135–43.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rahul Koushik BK. Chapter 16: kidney transplantation-the recipient: Mc Graw Hill Medical; 2008.

    Google Scholar 

  19. Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR. Laparoscopic live donor nephrectomy. Transplantation. 1995;60(9):1047–9.

    CAS  PubMed  Google Scholar 

  20. Giessing M. Laparoscopic living-donor nephrectomy. Nephrology Dialysis Transplant 2004;19:36–40.

    Article  Google Scholar 

  21. Kokkinos C, Nanidis T, Antcliffe D, Darzi AW, Tekkis P, Papalois V. Comparison of laparoscopic versus hand-assisted live donor nephrectomy. Transplantation. 2007;83(1):41–7.

    Article  PubMed  Google Scholar 

  22. Nanidis TG, Antcliffe D, Kokkinos C, Borysiewicz CA, Darzi AW, Tekkis PP, et al. Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis. Ann Surg. 2008;247(1):58–70.

    Article  PubMed  Google Scholar 

  23. Horgan S, Vanuno D, Sileri P, Cicalese L, Benedetti E. Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation. 2002;73(9):1474–9.

    Article  PubMed  Google Scholar 

  24. Giacomoni A, Di Sandro S, Lauterio A, Concone G, Buscemi V, Rossetti O, et al. Robotic nephrectomy for living donation: surgical technique and literature systematic review. Am J Surg. 2016;211(6):1135–42.

    Article  PubMed  Google Scholar 

  25. Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10):959–66.

    Article  CAS  PubMed  Google Scholar 

  26. Patel S, Cassuto J, Orloff M, Tsoulfas G, Zand M, Kashyap R, et al. Minimizing morbidity of organ donation: analysis of factors for perioperative complications after living-donor nephrectomy in the United States. Transplantation. 2008;85(4):561–5.

    Article  PubMed  Google Scholar 

  27. Mjoen G, Oyen O, Holdaas H, Midtvedt K, Line PD. Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation. 2009;88(11):1273–9.

    Article  PubMed  Google Scholar 

  28. Hadjianastassiou VG, Johnson RJ, Rudge CJ, Mamode N. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery. Am J Transplant. 2007;7(11):2532–7.

    Article  CAS  PubMed  Google Scholar 

  29. Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, et al. Long-term consequences of kidney donation. N Engl J Med. 2009;360(5):459–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Clemens KK, Thiessen-Philbrook H, Parikh CR, Yang RC, Karley ML, Boudville N, et al. Psychosocial health of living kidney donors: a systematic review. Am J Transplant. 2006;6(12):2965–77.

    Article  CAS  PubMed  Google Scholar 

  31. Smith GC, Trauer T, Kerr PG, Chadban SJ. Prospective psychosocial monitoring of living kidney donors using the short Form-36 health survey: results at 12 months. Transplantation. 2004;78(9):1384–9.

    Article  PubMed  Google Scholar 

  32. Andersen MH, Mathisen L, Veenstra M, Oyen O, Edwin B, Digernes R, et al. Quality of life after randomization to laparoscopic versus open living donor nephrectomy: long-term follow-up. Transplantation. 2007;84(1):64–9.

    Article  PubMed  Google Scholar 

  33. Perry KT, Freedland SJ, Hu JC, Phelan MW, Kristo B, Gritsch AH, et al. Quality of life, pain and return to normal activities following laparoscopic donor nephrectomy versus open mini-incision donor nephrectomy. J Urol. 2003;169(6):2018–21.

    Article  PubMed  Google Scholar 

  34. Buell JF, Lee L, Martin JE, Dake NA, Cavanaugh TM, Hanaway MJ, et al. Laparoscopic donor nephrectomy vs. open live donor nephrectomy: a quality of life and functional study. Clin Transpl. 2005;19(1):102–9.

    Article  Google Scholar 

  35. Nicholson ML, Elwell R, Kaushik M, Bagul A, Hosgood SA. Health-related quality of life after living donor nephrectomy: a randomized controlled trial of laparoscopic versus open nephrectomy. Transplantation. 2011;91(4):457–61.

    PubMed  Google Scholar 

  36. Morris PJ. Transplantation–a medical miracle of the 20th century. N Engl J Med. 2004;23(351(26)):2.

    Google Scholar 

  37. Cassini MF, de Andrade MF, Tucci S. Surgical Complications of Renal Transplantation.

    Google Scholar 

  38. Gittes RF, Waters WB. Sexual impotence: the overlooked complication of a second renal transplant. J Urol. 1979;121(6):719–20.

    Article  CAS  PubMed  Google Scholar 

  39. Nanni G, Tondolo V, Citterio F, Romagnoli J, Borgetti M, Boldrini G, et al. Comparison of oblique versus hockey-stick surgical incision for kidney transplantation. Transplant Proc. 2005;37(6):2479–81.

    Article  CAS  PubMed  Google Scholar 

  40. Khan T. Post kidney transplant lymphoceles: meticulous ligation of lymphatics reduces incidence. 2011.

    Google Scholar 

  41. Baston CHM, Preda A, Gener I, Manea I, Voinea S, et al. Comparative urologic complications of ureteroneocystostomy in kidney transplantation: transvesical Leadbetter-Politano versus extravesical lich-Gregoir technique. Transplant Proc. 2014;46(1):3.

    Article  Google Scholar 

  42. Zilinska ZCM, Trebaticky B, Breza J, Slobodnik L, Breza J, et al. Vascular complications after renal transplantation. Bratisl Lekárske Listy. 2010;111(11):3.

    Google Scholar 

  43. Mangus RSHB. Stented versus nonstented extravesical ureteroneocystostomy in renal transplantation: a metaanalysis. Am J Transplant. 2004;4(11):7.

    Article  Google Scholar 

  44. MT. BB. Modified extravesical ureteroneocystostomy in cadaveric kidney transplantation with completely duplicated ureters: a case report. J Transplant Technol Res. 2014;04(2).

    Google Scholar 

  45. NHSBT. Taking organ transplantation to 2020. In: England N, editor. Bristol: NHSBT; 2018.

    Google Scholar 

  46. Aubert O, Kamar N, Vernerey D, Viglietti D, Martinez F, Duong-Van-Huyen JP, et al. Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study. BMJ. 2015;351:h3557.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Lucarelli G, Bettocchi C, Battaglia M, Impedovo SV, Vavallo A, Grandaliano G, et al. Extended criteria donor kidney transplantation: comparative outcome analysis between single versus double kidney transplantation at 5 years. Transplant Proc. 2010;42(4):1104–7.

    Article  CAS  PubMed  Google Scholar 

  48. Remuzzi G, Grinyo J, Ruggenenti P, Beatini M, Cole EH, Milford EL, et al. Early experience with dual kidney transplantation in adults using expanded donor criteria. Double kidney transplant group (DKG). J Am Soc Nephrol. 1999;10(12):2591–8.

    CAS  PubMed  Google Scholar 

  49. Remuzzi G, Ruggenenti P. Renal transplantation: single or dual for donors aging > or =60 years? Transplantation. 2000;69(10):2000–1.

    Article  CAS  PubMed  Google Scholar 

  50. Schaffer M, Schier R, Napirei M, Michalski S, Traska T, Viebahn R. Sirolimus impairs wound healing. Langenbeck’s Arch Surg. 2007;392(3):297–303.

    Article  Google Scholar 

  51. Kobayashi KCM, Rossman LL, Kyriakides PN, Kahan BD, Cohen AM. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 2007;27(4).

    Article  PubMed  Google Scholar 

  52. Ghazanfar ATA, Augustine T, Pararajasingam R, Riad H, Chalmers N. Management of transplant renal artery stenosis and its impact on long-term allograft survival: a single-Centre experience. Nephrol Dial Transplant. 2011;26(1):7.

    Article  Google Scholar 

  53. Voiculescu ASM, Hollenbeck M, Braasch S, Luther B, Sandmann W, Jung G, Mödder U, Grabensee B. Management of arterial stenosis affecting kidney graft perfusion: a single-centre study in 53 patients. Am J Transplant. 2005;5(7):7.

    Article  Google Scholar 

  54. Leertouwer TCGE, Bosch JL, van Jaarsveld BC, van Dijk LC, Deinum J, Man In ’t Veld AJ. Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology. 2000;216(1):7.

    Article  Google Scholar 

  55. Baig MA, Khan T, Mousa D. Post transplant ureteric stenosis causing allograft hydronephrosis and calyceal rupture: salvage side to side ureteroneocystostomy. Saudi J Kidney Dis Transpl. 2010;21(3):504–6.

    PubMed  Google Scholar 

  56. Keller H, Noldge G, Wilms H, Kirste G. Incidence, diagnosis, and treatment of ureteric stenosis in 1298 renal transplant patients. Transpl Int. 1994;7(4):253–7.

    Article  CAS  PubMed  Google Scholar 

  57. Golriz M, Klauss M, Zeier M, Mehrabi A. Prevention and management of lymphocele formation following kidney transplantation. Transplant Rev (Orlando). 2017;31(2):100–5.

    Article  Google Scholar 

  58. Lucewicz A, Wong G, Lam VW, Hawthorne WJ, Allen R, Craig JC, et al. Management of primary symptomatic lymphocele after kidney transplantation: a systematic review. Transplantation. 2011;92(6):663–73.

    Article  PubMed  Google Scholar 

  59. Wagenaar S, Nederhoed JH, Hoksbergen AWJ, Bonjer HJ, Wisselink W, van Ramshorst GH. Minimally invasive, laparoscopic, and robotic-assisted techniques versus open techniques for kidney transplant recipients: a systematic review. Eur Urol. 2017;72(2):205–17.

    Article  PubMed  Google Scholar 

  60. Hosgood SA, Yang B, Bagul A, Mohamed IH, Nicholson ML. A comparison of hypothermic machine perfusion versus static cold storage in an experimental model of renal ischemia reperfusion injury. Transplantation. 2010;89(7):830–7.

    Article  PubMed  Google Scholar 

  61. Jochmans I, O’Callaghan JM, Pirenne J, Ploeg RJ. Hypothermic machine perfusion of kidneys retrieved from standard and high-risk donors. Transplant international: official journal of the European society for. Organ Transplantation. 2015;28(6):665–76.

    Google Scholar 

  62. Hosgood SA, Barlow AD, Hunter JP, Nicholson ML. Ex vivo normothermic perfusion for quality assessment of marginal donor kidney transplants. Br J Surg. 2015;102(11):1433–40.

    Article  CAS  PubMed  Google Scholar 

  63. Chadha R, Hossain MA, Bagul A. Optimising organs for transplantation: is normothermic machine perfusion the answer? Expert Rev Med Devices. 2016;13(3):221–3.

    Article  CAS  PubMed  Google Scholar 

  64. Doizi S, Kamphuis G, Giusti G, Palmero JL, Patterson JM, Proietti S, Straub M, De La Rosette J, Traxer O. First clinical evaluation of a new single-use flexible cystoscope dedicated to double-J stent removal (Isiris™): a European prospective multicenter study. World J Urol. 2017;35(8):1269–75.

    Article  PubMed  Google Scholar 

  65. Rassweiler MC, Michel MS, Ritter M, Honeck P. Magnetic ureteral stent removal without cystoscopy: a randomized controlled trial. J Endourol. 2017;31(8):762–6.

    Article  PubMed  Google Scholar 

  66. Mallon DH, Riddiough GE, Summers DM, Butler AJ, Callaghan CJ, Bradbury LL, Bardsley V, Broecker V, Saeb-Parsy K, Torpey N, Bradley JA, Pettigrew GJ. Successful transplantation of kidneys from elderly circulatory death donors by using microscopic and macroscopic characteristics to guide single or dual implantation. Am J Transplant. 2015;15(11):2931–9.

    Article  CAS  PubMed  Google Scholar 

  67. Ekser B, Furian L, Broggiato A, Silvestre C, Pierobon ES, Baldan N, Rigotti P. Technical aspects of unilateral dual kidney transplantation from expanded criteria donors: experience of 100 patients. Am J Transplant. 2010;10(9):2000–7.

    Article  CAS  PubMed  Google Scholar 

  68. Ayorinde JO, Summers DM, Pankhurst L, Laing E, Deary AJ, Hemming K, Wilson ECF, Bardsley V, Neil DA, Pettigrew GJ. PreImplantation Trial of Histopathology In renal Allografts (PITHIA): a stepped-wedge cluster randomised controlled trial protocol. BMJ Open. 2019;9(1):e026166.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Snanoudj R, Timsit MO, Rabant M, Tinel C, Lazareth H, Lamhaut L, Martinez F, Legendre C. Dual kidney transplantation: is it worth it? Transplantation. 2017;101(3):488–97.

    Article  PubMed  Google Scholar 

  70. van den Berg TAJ, Minnee RC, Nieuwenhuijs-Moeke GJ, Bakker SJL, Pol RA. The effect of perioperative antiplatelet/anticoagulant therapy on the incidence of early postoperative thromboembolic complications and bleeding in kidney transplantation. - a dual center retrospective cohort study of 2000 kidney transplant recipients. Transplantation. 2018;102:S186.

    Article  Google Scholar 

  71. Eng M, Brock G, Li X, Chen Y, Ravindra KV, Buell JF, Marvin MR. Perioperative anticoagulation and antiplatelet therapy in renal transplant: is there an increase in bleeding complication? Clin Transpl. 2011;25(2):292–6.

    Article  PubMed  Google Scholar 

  72. Breda A, Territo A, Gausa L, Tuğcu V, Alcaraz A, Musquera M, Decaestecker K, Desender L, Stockle M, Janssen M, Fornara P, Mohammed N, Siena G, Serni S, Guirado L, Facundo C, Doumerc N. Robot-assisted kidney transplantation: the European experience. Eur Urol. 2018;73(2):273–81.

    Article  PubMed  Google Scholar 

  73. Sood A, Ghosh P, Menon M, Jeong W, Bhandari M, Ahlawat R. Robotic renal transplantation: current status. J Minim Access Surg. 2015;11(1):35.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Peng P, Ding Z, He Y, Zhang J, Wang X, Yang Z. Hypothermic machine perfusion versus static cold storage in deceased donor kidney transplantation: a systematic review and meta-analysis of randomized controlled trials. Artif Organs. 2018;43(5):478–89.

    Article  PubMed  Google Scholar 

  75. Hosgood SA, Saeb-Parsy K, Wilson C, Callaghan C, Collett D, Nicholson ML. Protocol of a randomised controlled, open-label trial of ex vivo normothermic perfusion versus static cold storage in donation after circulatory death renal transplantation. BMJ Open. 2017;7(1):e012237.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Bahmani B, Uehara M, Jiang L, Ordikhani F, Banouni N, Ichimura T, Solhjou Z, Furtmüller GJ, Brandacher G, Alvarez D, von Andrian UH, Uchimura K, Xu Q, Vohra I, Yilmam OA, Haik Y, Azzi J, Kasinath V, Bromberg JS, McGrath MM, Abdi R. Targeted delivery of immune therapeutics to lymph nodes prolongs cardiac allograft survival. J Clin Investig. 2018;128(11):4770–86.

    Article  PubMed  Google Scholar 

  77. Hosgood SA, Thompson E, Moore T, Wilson CH, Nicholson ML. Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors. Br J Surg. 2018;105(4):388–94.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology and Transplantation, Royal Free Hospital, London, UK

    Mohammad Ayaz Hossain & Reza Motallebzadeh

  2. Department of Academic Surgery, Oxford University Hospital, Oxford, UK

    Radhika Chadha

  3. Department of Renal Transplantation, Leicester General Hospital, Leicester, UK

    Atul Bagul

  4. Division of Surgery and Interventional Sciences; Centre for Transplantation, Department of Renal Medicine; and Institute of Immunity and Transplantation, University College London, London, UK

    Reza Motallebzadeh

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  1. Mohammad Ayaz Hossain
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  2. Radhika Chadha
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  3. Atul Bagul
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  4. Reza Motallebzadeh
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Correspondence to Reza Motallebzadeh .

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  1. The Liver Unit, Aintree University Hospitals, NHS Foundation Trust, Liverpool, UK

    Rafael Díaz-Nieto

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Hossain, M.A., Chadha, R., Bagul, A., Motallebzadeh, R. (2019). Kidney Transplantation. In: Díaz-Nieto, R. (eds) Procurement and Transplantation of Abdominal Organs in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-21370-1_2

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