Salvage of compromised renal vessels in kidney transplantation using third-party cadaveric extenders: impact on posttransplant anti-HLA antibody formation

Transplantation
Mahesh C GoelDaniel J Cook

Abstract

Kidney transplant surgery can be complicated by short, attenuated, or injured renal vessels which are now more frequently encountered with laparoscopic right donor nephrectomy. We describe a technique to overcome this problem in seven recipients (2 cadaveric and 5 living donors) by constructing third-party "vascular extenders" using cadaveric iliac vessels retrieved previously and preserved at 4 degrees C in University of Wisconsin solution. Mean vessel cold storage time was 25.7 days (range, 2-56 days). Immunosuppression consisted of sirolimus, mycophenolate mofetil, and steroids. Prompt reperfusion of all allografts was observed, and there were no surgical complications. Integrity of the extenders was confirmed using serial MAG3 renal scans and magnetic resonance angiography. Mean serum creatinine was 1.44 mg/dl at 19.2 months (range, 0.7-2 mg/dl at 3-31 months). Each recipient had a negative posttransplant kidney donor specific flow cytometry crossmatch. Two recipients developed HLA antibodies, one to DR7 and another DR13 (mismatched to the vessel donor) at 4 and 11 months posttransplant, respectively.

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Citations

Jan 20, 2006·Transplantation·Gregory S RosenblattJohn M Barry
Oct 8, 2013·Urology·Stuart M Flechner
Sep 18, 2007·The Journal of Urology·Rizk El-Galley
Feb 13, 2007·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·S Ferrari-LacrazJ Villard
Jul 2, 2009·Urology·Stuart M Flechner
Jan 3, 2006·International Braz J Urol : Official Journal of the Brazilian Society of Urology·Jose C Baptista-SilvaMarcio F Signorelli
May 14, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Neetika GargDidier A Mandelbrot
Nov 15, 2020·Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation·Lucy Victoria HanlonJerome Martin Laurence
Jan 20, 2018·Journal of Vascular Surgery Cases and Innovative Techniques·Sandra Garcia ArozIvo Tzvetanov

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