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Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

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ABSTRACT

On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression.

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Surgical techniques for kidney harvesting and transplantation. A – Standard open approach for abdominal and thoracic organs harvesting from cadaveric donor; B – standard approach for kidney transplantation (“hockey stick” incision); C – incision for both anterior transperitoneal and anterior retroperitoneal approach for live donor nephrectomy (LDN); D – belly-button laparoendoscopic single-site (LESS) live donor nephrectomy (a) and Pfannenstiel LESS live donor nephrectomy (b); E – approach for LDN through lumbotomy incision; F – hand-assisted laparoscopic approach. Hand-assisted device is placed in the midline over the umbilicus (a) or through Pfannenstiel incision (b); G – totally laparoscopic approach
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Figure 0001: Surgical techniques for kidney harvesting and transplantation. A – Standard open approach for abdominal and thoracic organs harvesting from cadaveric donor; B – standard approach for kidney transplantation (“hockey stick” incision); C – incision for both anterior transperitoneal and anterior retroperitoneal approach for live donor nephrectomy (LDN); D – belly-button laparoendoscopic single-site (LESS) live donor nephrectomy (a) and Pfannenstiel LESS live donor nephrectomy (b); E – approach for LDN through lumbotomy incision; F – hand-assisted laparoscopic approach. Hand-assisted device is placed in the midline over the umbilicus (a) or through Pfannenstiel incision (b); G – totally laparoscopic approach

Mentions: Besides these points, throughout the healing process, LLDN has cosmetic drawbacks, with three or four port incisions required over the single incision of OLDN (especially mini-OLDN) [29]. It is also far more expensive than OLDN, especially when it comes to postoperative complications [19, 30]. Overall, then, it seems that the adoption of laparoscopic techniques is more about shifting public opinion about live donors than replacing OLDN, especially as only a quarter of the general population are in favor of LDN [18, 31]. The availability of LLDN has been credited by the United Network for Organ Sharing (UNOS) as a factor driving a significant increase in LDN [32–34]. This is similar to observations made within the field of urology 10–15 years ago, where laparoscopic and open surgery started being performed in cases of prostate cancer [35]. In the future, it is proposed that these procedures be applied to kidney transplantations via the techniques described in Figure 1.


Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation
Surgical techniques for kidney harvesting and transplantation. A – Standard open approach for abdominal and thoracic organs harvesting from cadaveric donor; B – standard approach for kidney transplantation (“hockey stick” incision); C – incision for both anterior transperitoneal and anterior retroperitoneal approach for live donor nephrectomy (LDN); D – belly-button laparoendoscopic single-site (LESS) live donor nephrectomy (a) and Pfannenstiel LESS live donor nephrectomy (b); E – approach for LDN through lumbotomy incision; F – hand-assisted laparoscopic approach. Hand-assisted device is placed in the midline over the umbilicus (a) or through Pfannenstiel incision (b); G – totally laparoscopic approach
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016594&req=5

Figure 0001: Surgical techniques for kidney harvesting and transplantation. A – Standard open approach for abdominal and thoracic organs harvesting from cadaveric donor; B – standard approach for kidney transplantation (“hockey stick” incision); C – incision for both anterior transperitoneal and anterior retroperitoneal approach for live donor nephrectomy (LDN); D – belly-button laparoendoscopic single-site (LESS) live donor nephrectomy (a) and Pfannenstiel LESS live donor nephrectomy (b); E – approach for LDN through lumbotomy incision; F – hand-assisted laparoscopic approach. Hand-assisted device is placed in the midline over the umbilicus (a) or through Pfannenstiel incision (b); G – totally laparoscopic approach
Mentions: Besides these points, throughout the healing process, LLDN has cosmetic drawbacks, with three or four port incisions required over the single incision of OLDN (especially mini-OLDN) [29]. It is also far more expensive than OLDN, especially when it comes to postoperative complications [19, 30]. Overall, then, it seems that the adoption of laparoscopic techniques is more about shifting public opinion about live donors than replacing OLDN, especially as only a quarter of the general population are in favor of LDN [18, 31]. The availability of LLDN has been credited by the United Network for Organ Sharing (UNOS) as a factor driving a significant increase in LDN [32–34]. This is similar to observations made within the field of urology 10–15 years ago, where laparoscopic and open surgery started being performed in cases of prostate cancer [35]. In the future, it is proposed that these procedures be applied to kidney transplantations via the techniques described in Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression.

No MeSH data available.


Related in: MedlinePlus