Shapiro, R

Starzl, TE

Tzakis, AG

English

Name not available

Bilateral venous reconstruction of pediatric en-bloc kidneys for transplantation

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Mt'Me' 7' tMYz'ms; cd tnl2etiei'tztttt VENOUS RECONSTRUCTION OF PEDIATRIC EN-BLOC KIDNEYS FOR TRANSPLANTATION1 Even though cadaveric kidneys are a scarce resource, pedi-atric kidneys are frequently discarded because of the small size of the organs or because of damage to the specimen during the procurement. In the latter circumstance, back table reconstruc-I This work was supported by Research Grants from the Veteran. Administration and Project Grant DK 29961 from the National Insti-tutes of Health, Bethesda, MD. tion can be used (1). We report here the successful use of a set of 6-antigen-matched pediatric kidneys that had sustained a major procurement injury. The recipient was a 24-year-old woman with endstage renal disease secondary to insulin-dependent diabetes mellitus_ Her HLA type was At. 'JO B28,12 DR".. A 6-antigen-matched set of pediatric en-bloc kidneys from a three-year-old donor was I 1056 '-TRANSPLANTATION Vol SO, No. 6 In!. vena cava Aorta FIGURE 1. Pediatric en bloc kidneys with divided inferior vena cava. FIGURE 2. Vein graft interposition. offered for her and accepted. When the kidneys were examined, it was noted that the vena cava had been split in half and was unusable (Fig. 1). A segment of fresh iliac vein graft from an adult cadaveric donor of the same blood type was taken from the refrigerator (Fig. 2). A Carrel patch of vena cava was left on each renal vein, and anastomosed end·to·side to the iliac vein graft with running 8-0 Novafil (Fig. 3). The superior end of the vein graft was closed with running 6-0 prolene. The donor aorta was prepared in the usual way, ligating the lumbar and other branches, and oversewing the aorta superiorly. The reconstructed kidneys were revascularized after a cold ischemia interval of 30 hand 29 min. Separate ureteroneocystostomies wae performed. The kidneys functioned immediately and the patient was discharged 12 days later with a creatinine of 1.3 mg/d!. She remains well 13 months postoperatively with a creatinine of 1.1 mg/d!. Vein graft FIGURE 3. After reconstruction. Although arterial and venous reconstruction with stored vessel grafts often has been used successfully to salvage dam-aged kidneys (1), the type of problem described here with en-bloc kidneys had not been previously encountered. The kind of reconstruction used requires meticulous technique but is not particularly difficult. Magnification with surgicalloupes is an invaluable aid. This salvage technique should be useful, albeit in a small way, to help increase the number of organs available for transplantation. Wengerter et al. (2) have emphasized that pediatric kidneys, which are often discarded because of their small size, can be used for adulta. RON SHAPIRO ANDREAS G. TZAKIS THOMAS E. STARZL2 The Departmenl of Surgery University Health Center of Pittsburgh The Veterans Administration Medical Center Pittsburgh. Pennsylvania 2 Reprint requesU! should be sent to Thomas E. Stant, M.D., Ph.D., Department of Surgery. 3601 Fifth Ave. Falk Clinic SC. PitU!. burgh. PA 15213. REFERENCES 1. Tzakis A. Mazzaferro V. Pan C. et al. Renal artery reconstruction for harvesting injuries in kidney transplantation: with particular reference to the use of vascular allografts. Transplant Int 1988; 1: SO. 2. Wengerter K. Matas AJ. Tellis VA. Quinn T. Soberman R. Veith FJ. Transplantation of pediatric donor kidneys to adult recipi· ents. Ann Sure 1986; 204: 172. Received 8 March 1990. Accepted 25 May 1990. RECURRENCE OF LUPUS NEPHRITIS IN A RENAL ALLOGRAFT WITH HISTOLOGIC TRANSFORMATION OF THE LESION Nearly 15 years have passed since the Advisory Committee to the Renal Transplant Registry first reported satisfactory allograft and patient survival in patients with end-stage renal disease secondary to systemic lupus erythematosus (J). Sub-sequent to this favorable report, lupus patients with ESRD have been referred for renal transplantation in increasing num-bers. However, while the total number of transplanted patients with SLE has increased, recurrence of lupus nephritis in the transplanted kidney bas been uncommon (2-6). The current report describes a case of recurrent lupus nephritis with histo-logic transformation of the lesion. A 29-year-old woman developed end-stage renal disease as a 

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Bilateral venous reconstruction of pediatric en-bloc kidneys for transplantation

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