U 002 Nierentransplantation / kidney transplant

A nice you tube video ( cartoon) of a transplant surgery

Live Donor Nephrectomy with vaginal extraction

Donor nephrectomies are being done in some patients via a different approach at John Hopkins.  A case report was done for a patient presented in AJT July 2010 issue where the donor kidney was removed via vaginal route.  The warm ischemia time was 3 min and the post op pain was less; hospital stay was shorter and the cosmetic outcome was more desirable.  This is a creative approach to a surgical technique.
Lets see where we stand with this in the future.

For now its just one patient and we have to wait and see further work in this field. An editorial along with this case report is a must read as well. It discusses the potential hazards of this type of approach.

http://www.ncbi.nlm.nih.gov/pubmed/20553450
http://www.ncbi.nlm.nih.gov/pubmed/20353482

Kidney Transplant as an Outpatient Procedure

This ATC 2010, North Shore/LIJ Center of Kidney Transplantation presented an abstract about a 48 hour discharge kidney transplant program. A nice editorial on this can be seen in the most recent ASN Kidney News.  Selected patients with the right multi-team approach along with Nephrologists, Social workers and coordinators, this is very possible.
The re admission rate was low, complications were low along with a cost effective strategy.

Check it out at ASN Kidney News online version.

Kidney Autotransplantation

Autotransplantation is something not that talked about. It is mainly used to recover or stabalize renal impairment due to renovascular or ureteric disorders to avoid nephrectomies. Perhaps due to major advances in interventional nephrology and radiology and immunosuppresive agents, this mode of treatment has fallen out of favor. Renal autotransplantation was first performed successfully in 1963 on a patient with severe
ureteral damage.  Bodie et al. reported the longest series of 23 patients who underwent renal
autotransplantation for extensive ureteral injuries, and were followed up for up to 14 years.  

What are some of the reasons that leads to autotransplantation of the kidney? at least historically

1. Iatrogenic ureter lesion 
2. Gross hematuria due to kidney vascular abnormalities
3. Renal artery stenosis
4. Long ureteric stenosis
5. Ureteral strictures
6. TCC of upper GU organs
7. RP Fibrosis


Some good references
http://www.ncbi.nlm.nih.gov/pubmed/15134964
http://www.ncbi.nlm.nih.gov/pubmed/13960761
http://www.ncbi.nlm.nih.gov/pubmed/12556645
http://www.ncbi.nlm.nih.gov/pubmed/3534311