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A Novel Technique for En Bloc Kidney Transplantation from Infant Donors with Extremely Low Body Weight by using the Distal Abdominal Aorta as an Outflow Tract

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons | 16 Feb 2018

H Dai, L Peng, F Peng, G Lan, Y Wang, J Chen, L Liu, C Gao, Y Guo, C Fang, M Nie, W Long and S Yu
Abstract
Pediatric kidney donors remain underutilized due to the high risk of postoperative thrombosis. To address this problem, we developed a novel en bloc kidney transplantation technique using donor thoracic aorta and the distal abdominal aorta as inflow and outflow tracts, respectively. Briefly, 8 kidneys from deceased infant donors under 5 months old and with low body weight (1.9-4.9 kg) were transplanted en bloc into 4 pediatric and 4 adult patients. The donor’s common iliac artery or external iliac artery was anastomosed to the recipient’s distal external iliac artery or inferior epigastric artery, respectively, as an outflow tract. Recipients received basiliximab or antithymocyte globulin as induction therapy followed by tacrolimus, mycophenolate mofetil, and prednisone but without prophylactic anticoagulation. Delayed graft function was observed in 1 patient but was reversed at 90 days post-transplant. Two patients had urine leakage, which was cured by conservative treatment. Two recipients developed lung infections that eventually cleared. No patients experienced post-transplant vascular thrombosis. After 1-1.5 years of follow up, all patients are well and have normal serum creatinine levels. In conclusion, this novel en bloc kidney transplantation technique using a modified arterial inflow and outflow tract can prevent vascular thrombosis and provide adequate graft function. This article is protected by copyright. All rights reserved.
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Concepts
Creatinine, Ureter, Inferior epigastric artery, Internal iliac artery, Abdominal aorta, Common iliac artery, Arteries of the abdomen, External iliac artery
MeSH headings
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