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Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants
BACKGROUND: Patients with more than two prior kidney transplant procedures pose unique surgical challenges. Once both the right and left retroperitoneal spaces have been dissected, intra-abdominal implantation is usually necessary. If the external iliac arteries have been used previously, it is some...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Hindawi
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262568/ https://www.ncbi.nlm.nih.gov/pubmed/35813933 http://dx.doi.org/10.1155/2022/3823066 |
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author | Al-Adwan, Yazan Singh, Navdeep Rajab, Amer Alebrahim, Musab Subramanian, Jayanthan Washburn, W. Kenneth Siddiqui, Farjad Limkemann, Ashley Chotai, Pranit N. Schenk, Austin |
author_facet | Al-Adwan, Yazan Singh, Navdeep Rajab, Amer Alebrahim, Musab Subramanian, Jayanthan Washburn, W. Kenneth Siddiqui, Farjad Limkemann, Ashley Chotai, Pranit N. Schenk, Austin |
author_sort | Al-Adwan, Yazan |
collection | PubMed |
description | BACKGROUND: Patients with more than two prior kidney transplant procedures pose unique surgical challenges. Once both the right and left retroperitoneal spaces have been dissected, intra-abdominal implantation is usually necessary. If the external iliac arteries have been used previously, it is sometimes necessary to use the aorta and vena cava for implantation. Gaining safe exposure in these cases can be complicated by history of prior laparotomy, adhesive disease, and other surgical histories. Case Presentation. A 58-year-old female with type 1 diabetes and end-stage renal disease presented for surgical evaluation for kidney transplant. Surgical history was notable for prior simultaneous kidney-pancreas transplant followed by both a living donor kidney transplant and a pancreas after kidney transplant. She had undergone both an allograft nephrectomy and an allograft pancreatectomy and currently had a nonfunctioning kidney in the left retroperitoneal position and a nonfunctioning pancreatic allograft on the right common iliac artery. The entire distal aortoiliac system was surgically inaccessible. She was listed for transplantation, and a cadaveric graft was allocated. Intraoperatively, severe lower abdominal and pelvic adhesions prevented any use of the iliac system. A left native nephrectomy was performed, and the allograft was implanted in the left orthotopic position. The native left renal vein was used for outflow, the donor renal artery was joined end-to-side to the infrarenal aorta, and a uretero-ureterostomy was created. The operation was uneventful. The allograft functioned without delay, and almost one year later, the GFR is approximately 50 mg/dL. CONCLUSION: The left orthotopic position can be a good choice for kidney transplant candidates with histories of prior complex lower abdominal surgery. |
format | Online Article Text |
id | pubmed-9262568 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-92625682022-07-08 Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants Al-Adwan, Yazan Singh, Navdeep Rajab, Amer Alebrahim, Musab Subramanian, Jayanthan Washburn, W. Kenneth Siddiqui, Farjad Limkemann, Ashley Chotai, Pranit N. Schenk, Austin Case Rep Transplant Case Report BACKGROUND: Patients with more than two prior kidney transplant procedures pose unique surgical challenges. Once both the right and left retroperitoneal spaces have been dissected, intra-abdominal implantation is usually necessary. If the external iliac arteries have been used previously, it is sometimes necessary to use the aorta and vena cava for implantation. Gaining safe exposure in these cases can be complicated by history of prior laparotomy, adhesive disease, and other surgical histories. Case Presentation. A 58-year-old female with type 1 diabetes and end-stage renal disease presented for surgical evaluation for kidney transplant. Surgical history was notable for prior simultaneous kidney-pancreas transplant followed by both a living donor kidney transplant and a pancreas after kidney transplant. She had undergone both an allograft nephrectomy and an allograft pancreatectomy and currently had a nonfunctioning kidney in the left retroperitoneal position and a nonfunctioning pancreatic allograft on the right common iliac artery. The entire distal aortoiliac system was surgically inaccessible. She was listed for transplantation, and a cadaveric graft was allocated. Intraoperatively, severe lower abdominal and pelvic adhesions prevented any use of the iliac system. A left native nephrectomy was performed, and the allograft was implanted in the left orthotopic position. The native left renal vein was used for outflow, the donor renal artery was joined end-to-side to the infrarenal aorta, and a uretero-ureterostomy was created. The operation was uneventful. The allograft functioned without delay, and almost one year later, the GFR is approximately 50 mg/dL. CONCLUSION: The left orthotopic position can be a good choice for kidney transplant candidates with histories of prior complex lower abdominal surgery. Hindawi 2022-06-30 /pmc/articles/PMC9262568/ /pubmed/35813933 http://dx.doi.org/10.1155/2022/3823066 Text en Copyright © 2022 Yazan Al-Adwan et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Al-Adwan, Yazan Singh, Navdeep Rajab, Amer Alebrahim, Musab Subramanian, Jayanthan Washburn, W. Kenneth Siddiqui, Farjad Limkemann, Ashley Chotai, Pranit N. Schenk, Austin Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants |
title | Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants |
title_full | Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants |
title_fullStr | Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants |
title_full_unstemmed | Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants |
title_short | Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants |
title_sort | orthotopic kidney transplant as a fifth intra-abdominal organ after two previous kidney and two previous pancreas transplants |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262568/ https://www.ncbi.nlm.nih.gov/pubmed/35813933 http://dx.doi.org/10.1155/2022/3823066 |
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