LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.262 |
Resumo: | Introduction: The presence of multiple renal vessels is frequent in the general population and, when present in a donor, increases the complexity of renal transplantation surgery, increasing the risk of complications. Although transplantation of cadaver donor grafts with these characteristics is accepted, the same procedure in living donor remains controversial. The objective of this work is to present the case of a living donor renal transplant surgery with complex vascular anatomy - two arteries and two renal veins. Clinical case: 42-year-old woman with end stage renal disease due to IgA nephropathy, on regular hemodialysis program for 9 months, evaluated in more than one center for living donor renal transplantation and rejected by the complexity of the vascular anatomy of the donor - right kidney with two arteries and two short renal veins. In our center, where vascular surgery integrates the multidisciplinary team of renal transplantation, the transplant was accepted considering that the ex-vivo vascular reconstruction of the graft (back table) was technically feasible. Arterial reconstruction was performed on a lateral-lateral anastomosis of the two renal arteries. Venous reconstruction included the stretching of the renal veins with the great saphenous vein of the recipient and its posterior lateral-lateral anastomosis. The kidney was implanted in the recipient's right iliac fossa. Immediate diuresis after dislodging was observed, with a rapid decrease in creatinine values to normal and discharged on the 16th postoperative day. Conclusion: Organ shortage is an important limiting factor for renal transplantation. Inclusion of donors with multiple renal vessels has shown good results and may increase organ availability. The integration of an experienced vascular surgeon in the multidisciplinary team of renal transplantation allows the accomplishment of complex arterial and venous reconstructions in grafts with less favorable vascular anatomy. |
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LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASETRANSPLANTE RENAL EM DADOR VIVO — UM CASO VASCULAR COMPLEXORenal transplantationLiving donor, Complex anatomyVascular reconstructionTransplantação renalDador vivoAnatomia complexaReconstrução vascularIntroduction: The presence of multiple renal vessels is frequent in the general population and, when present in a donor, increases the complexity of renal transplantation surgery, increasing the risk of complications. Although transplantation of cadaver donor grafts with these characteristics is accepted, the same procedure in living donor remains controversial. The objective of this work is to present the case of a living donor renal transplant surgery with complex vascular anatomy - two arteries and two renal veins. Clinical case: 42-year-old woman with end stage renal disease due to IgA nephropathy, on regular hemodialysis program for 9 months, evaluated in more than one center for living donor renal transplantation and rejected by the complexity of the vascular anatomy of the donor - right kidney with two arteries and two short renal veins. In our center, where vascular surgery integrates the multidisciplinary team of renal transplantation, the transplant was accepted considering that the ex-vivo vascular reconstruction of the graft (back table) was technically feasible. Arterial reconstruction was performed on a lateral-lateral anastomosis of the two renal arteries. Venous reconstruction included the stretching of the renal veins with the great saphenous vein of the recipient and its posterior lateral-lateral anastomosis. The kidney was implanted in the recipient's right iliac fossa. Immediate diuresis after dislodging was observed, with a rapid decrease in creatinine values to normal and discharged on the 16th postoperative day. Conclusion: Organ shortage is an important limiting factor for renal transplantation. Inclusion of donors with multiple renal vessels has shown good results and may increase organ availability. The integration of an experienced vascular surgeon in the multidisciplinary team of renal transplantation allows the accomplishment of complex arterial and venous reconstructions in grafts with less favorable vascular anatomy. Introdução: A presença de múltiplos vasos renais é frequente na população geral e, quando presente num dador, aumenta a complexidade da cirurgia de transplantação renal, aumentando o risco de complicações. Embora a transplantação de enxertos de dador cadáver com estas características seja aceite, o mesmo procedimento em dador vivo permanece controverso. O objetivo deste trabalho é apresentar o caso de uma cirurgia de transplantação de dador vivo com anatomia vascular complexa – duas artérias e duas veias renais. Caso Clínico: Mulher de 42 anos, com doença renal crónica terminal (DRCT) por nefropatia IgA, em programa regular de hemodiálise há 9 meses, avaliada em mais de um centro para transplantação renal de dador vivo e recusada pela complexidade da anatomia vascular do par dador - rim direito com duas artérias e duas veias renais curtas. No nosso centro, onde a cirurgia vascular integra a equipa multidisciplinar de transplantação renal, foi aceite o transplante considerando-se tecnicamente exequível a reconstrução vascular ex-vivo do enxerto (back table). Na reconstrução arterial foi realizada anastomose látero-lateral das duas artérias renais. A reconstrução venosa incluiu o alongamento das veias renais com veia safena interna (VSI) da recetora e a sua posterior anastomose em “cano de espingarda”. O rim foi implantado na fossa ilíaca direita da recetora. Verificou-se diurese imediata após desclampagem, com descida rápida dos valores de creatinina para o normal e com alta ao 16.º dia de pós-operatório. Conclusão: A escassez de órgãos é um importante fator limitante à transplantação renal. A inclusão de dadores com múltiplos vasos renais tem demonstrado bons resultados e pode aumentar a disponibilidade de órgãos. A integração de um cirurgião vascular experiente na equipa multidisciplinar de transplantação renal permite a realização de reconstruções arteriais e venosas complexas em enxertos com anatomia vascular menos favorável. Sociedade Portuguesa de Angiologia e Cirurgia Vascular2020-12-13T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.262oai:ojs.acvjournal.com:article/262Angiologia e Cirurgia Vascular; Vol. 16 No. 3 (2020): September; 181-185Angiologia e Cirurgia Vascular; Vol. 16 N.º 3 (2020): Setembro; 181-1852183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/262https://doi.org/10.48750/acv.262http://acvjournal.com/index.php/acv/article/view/262/206Copyright (c) 2020 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessPinto, VandaMinistro, AugustoSilvestre, LuísMendes Pedro, LuísLopez, NoéliaGuerra, JoséBaptista, Lucas2022-05-23T15:10:07Zoai:ojs.acvjournal.com:article/262Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:38.524181Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE TRANSPLANTE RENAL EM DADOR VIVO — UM CASO VASCULAR COMPLEXO |
title |
LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE |
spellingShingle |
LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE Pinto, Vanda Renal transplantation Living donor, Complex anatomy Vascular reconstruction Transplantação renal Dador vivo Anatomia complexa Reconstrução vascular |
title_short |
LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE |
title_full |
LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE |
title_fullStr |
LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE |
title_full_unstemmed |
LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE |
title_sort |
LIVING DONOR RENAL TRANSPLANTATION — A COMPLEX VASCULAR CASE |
author |
Pinto, Vanda |
author_facet |
Pinto, Vanda Ministro, Augusto Silvestre, Luís Mendes Pedro, Luís Lopez, Noélia Guerra, José Baptista, Lucas |
author_role |
author |
author2 |
Ministro, Augusto Silvestre, Luís Mendes Pedro, Luís Lopez, Noélia Guerra, José Baptista, Lucas |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Pinto, Vanda Ministro, Augusto Silvestre, Luís Mendes Pedro, Luís Lopez, Noélia Guerra, José Baptista, Lucas |
dc.subject.por.fl_str_mv |
Renal transplantation Living donor, Complex anatomy Vascular reconstruction Transplantação renal Dador vivo Anatomia complexa Reconstrução vascular |
topic |
Renal transplantation Living donor, Complex anatomy Vascular reconstruction Transplantação renal Dador vivo Anatomia complexa Reconstrução vascular |
description |
Introduction: The presence of multiple renal vessels is frequent in the general population and, when present in a donor, increases the complexity of renal transplantation surgery, increasing the risk of complications. Although transplantation of cadaver donor grafts with these characteristics is accepted, the same procedure in living donor remains controversial. The objective of this work is to present the case of a living donor renal transplant surgery with complex vascular anatomy - two arteries and two renal veins. Clinical case: 42-year-old woman with end stage renal disease due to IgA nephropathy, on regular hemodialysis program for 9 months, evaluated in more than one center for living donor renal transplantation and rejected by the complexity of the vascular anatomy of the donor - right kidney with two arteries and two short renal veins. In our center, where vascular surgery integrates the multidisciplinary team of renal transplantation, the transplant was accepted considering that the ex-vivo vascular reconstruction of the graft (back table) was technically feasible. Arterial reconstruction was performed on a lateral-lateral anastomosis of the two renal arteries. Venous reconstruction included the stretching of the renal veins with the great saphenous vein of the recipient and its posterior lateral-lateral anastomosis. The kidney was implanted in the recipient's right iliac fossa. Immediate diuresis after dislodging was observed, with a rapid decrease in creatinine values to normal and discharged on the 16th postoperative day. Conclusion: Organ shortage is an important limiting factor for renal transplantation. Inclusion of donors with multiple renal vessels has shown good results and may increase organ availability. The integration of an experienced vascular surgeon in the multidisciplinary team of renal transplantation allows the accomplishment of complex arterial and venous reconstructions in grafts with less favorable vascular anatomy. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-12-13T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.262 oai:ojs.acvjournal.com:article/262 |
url |
https://doi.org/10.48750/acv.262 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/262 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/262 https://doi.org/10.48750/acv.262 http://acvjournal.com/index.php/acv/article/view/262/206 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2020 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2020 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 16 No. 3 (2020): September; 181-185 Angiologia e Cirurgia Vascular; Vol. 16 N.º 3 (2020): Setembro; 181-185 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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