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Transplantation of a horseshoe kidney found during harvest operation of a cadaveric donor: a case report.

Yun S, Woo HD, Doo SW, Kwon SH, Noh H, Song D - J. Korean Med. Sci. (2014)

Bottom Line: Resistive index was 0.72.Glomerular filtration ratio was 84.69 mL/min on postoperative day 14.The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT
A 34-yr-old female was diagnosed as being brain dead. Preoperative ultrasound revealed no abnormal focal lesions. However, the horseshoe kidney was identified during organ harvest. En bloc nephrectomy was performed. The kidney was divided at the midline of isthmus. The divided right kidney was discarded due to numerous arteries and veins. The divided left kidney was transplanted. After declamping, the kidney was well perfused and started clearing. Resistive index was 0.72. Glomerular filtration ratio was 84.69 mL/min on postoperative day 14. The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.

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Gross finding of the kidney. (A) En bloc nephrectomy was performed. The left kidney had single renal artery (dark arrow) and vein, whereas the right kidney had numerous arteries (blank arrows) and veins (blank pentagons). The isthmus contained a broad band of normal parenchyma. Both kidneys showed no variation in urinary collecting system (blank triangle is the right ureter, dark triangle is the left ureter). (B) In bench surgery, the kidney was divided at midline of isthmus, preserving its vasculature and urinary collecting system. The edges of the renal remnant (outer layer) were approximated using 2-0 absorbable polyglactin sutures after inner layer renorrhaphy. (C) The divided left kidney was transplanted at recipient's right iliac fossa. The renal artery was anastomosed to recipient's right external iliac artery, and the renal vein anastomosed to the right external iliac vein, end to side fashion. Divided isthmus involving small part of kidney low pole remained dark red color and achieved hemostasis after declamping.
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Figure 1: Gross finding of the kidney. (A) En bloc nephrectomy was performed. The left kidney had single renal artery (dark arrow) and vein, whereas the right kidney had numerous arteries (blank arrows) and veins (blank pentagons). The isthmus contained a broad band of normal parenchyma. Both kidneys showed no variation in urinary collecting system (blank triangle is the right ureter, dark triangle is the left ureter). (B) In bench surgery, the kidney was divided at midline of isthmus, preserving its vasculature and urinary collecting system. The edges of the renal remnant (outer layer) were approximated using 2-0 absorbable polyglactin sutures after inner layer renorrhaphy. (C) The divided left kidney was transplanted at recipient's right iliac fossa. The renal artery was anastomosed to recipient's right external iliac artery, and the renal vein anastomosed to the right external iliac vein, end to side fashion. Divided isthmus involving small part of kidney low pole remained dark red color and achieved hemostasis after declamping.

Mentions: During organ harvest, the horseshoe kidney was identified. The isthmus was placed anterior to the aorta and the inferior vena cava. After harvesting the liver, en bloc nephrectomy was performed. In bench surgery, inspection revealed the left kidney having normal vasculature with single renal artery and vein, whereas the right kidney had numerous arteries and veins (Fig. 1A). The isthmus contained a broad band of normal parenchyma. The kidney did not have urinary collecting system variations or any other renal abnormalities. The kidney was divided at the midline of isthmus, preserving its vasculature and urinary collecting system. Intracorporeal suturing was used to repair the inner layer of the renal parenchyma with 3-0 polyglactin sutures for hemostasis. The edges of the renal remnant (outer layer) were approximated using 2-0 absorbable polyglactin sutures after inner layer renorrhaphy (Fig. 1B). The divided right kidney was discarded due to its numerous arteries and veins.


Transplantation of a horseshoe kidney found during harvest operation of a cadaveric donor: a case report.

Yun S, Woo HD, Doo SW, Kwon SH, Noh H, Song D - J. Korean Med. Sci. (2014)

Gross finding of the kidney. (A) En bloc nephrectomy was performed. The left kidney had single renal artery (dark arrow) and vein, whereas the right kidney had numerous arteries (blank arrows) and veins (blank pentagons). The isthmus contained a broad band of normal parenchyma. Both kidneys showed no variation in urinary collecting system (blank triangle is the right ureter, dark triangle is the left ureter). (B) In bench surgery, the kidney was divided at midline of isthmus, preserving its vasculature and urinary collecting system. The edges of the renal remnant (outer layer) were approximated using 2-0 absorbable polyglactin sutures after inner layer renorrhaphy. (C) The divided left kidney was transplanted at recipient's right iliac fossa. The renal artery was anastomosed to recipient's right external iliac artery, and the renal vein anastomosed to the right external iliac vein, end to side fashion. Divided isthmus involving small part of kidney low pole remained dark red color and achieved hemostasis after declamping.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129212&req=5

Figure 1: Gross finding of the kidney. (A) En bloc nephrectomy was performed. The left kidney had single renal artery (dark arrow) and vein, whereas the right kidney had numerous arteries (blank arrows) and veins (blank pentagons). The isthmus contained a broad band of normal parenchyma. Both kidneys showed no variation in urinary collecting system (blank triangle is the right ureter, dark triangle is the left ureter). (B) In bench surgery, the kidney was divided at midline of isthmus, preserving its vasculature and urinary collecting system. The edges of the renal remnant (outer layer) were approximated using 2-0 absorbable polyglactin sutures after inner layer renorrhaphy. (C) The divided left kidney was transplanted at recipient's right iliac fossa. The renal artery was anastomosed to recipient's right external iliac artery, and the renal vein anastomosed to the right external iliac vein, end to side fashion. Divided isthmus involving small part of kidney low pole remained dark red color and achieved hemostasis after declamping.
Mentions: During organ harvest, the horseshoe kidney was identified. The isthmus was placed anterior to the aorta and the inferior vena cava. After harvesting the liver, en bloc nephrectomy was performed. In bench surgery, inspection revealed the left kidney having normal vasculature with single renal artery and vein, whereas the right kidney had numerous arteries and veins (Fig. 1A). The isthmus contained a broad band of normal parenchyma. The kidney did not have urinary collecting system variations or any other renal abnormalities. The kidney was divided at the midline of isthmus, preserving its vasculature and urinary collecting system. Intracorporeal suturing was used to repair the inner layer of the renal parenchyma with 3-0 polyglactin sutures for hemostasis. The edges of the renal remnant (outer layer) were approximated using 2-0 absorbable polyglactin sutures after inner layer renorrhaphy (Fig. 1B). The divided right kidney was discarded due to its numerous arteries and veins.

Bottom Line: Resistive index was 0.72.Glomerular filtration ratio was 84.69 mL/min on postoperative day 14.The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT
A 34-yr-old female was diagnosed as being brain dead. Preoperative ultrasound revealed no abnormal focal lesions. However, the horseshoe kidney was identified during organ harvest. En bloc nephrectomy was performed. The kidney was divided at the midline of isthmus. The divided right kidney was discarded due to numerous arteries and veins. The divided left kidney was transplanted. After declamping, the kidney was well perfused and started clearing. Resistive index was 0.72. Glomerular filtration ratio was 84.69 mL/min on postoperative day 14. The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.

Show MeSH
Related in: MedlinePlus