Ann Surg Treat Res.  2017 Mar;92(3):168-172. 10.4174/astr.2017.92.3.168.

En bloc transplantation of horseshoe kidney in Korea

• Bang JB
• Lee JM
• Oh CK
• Lee KW
• Park JB
• Kim SJ
• Lee SH

• KMID: 2377560
• DOI: http://doi.org/10.4174/astr.2017.92.3.168

Abstract

Transplantation of the horseshoe kidney can be performed en bloc or split into 2 grafts according to the vascular anomaly and the existence of the urinary collecting system in isthmus. From 2011 to 2014, there were 3 horseshoe kidney transplantations in Korea and transplantations were performed at 2 different centers. The transplantations were carried out successfully for all recipients without complications. All recipients have shown good graft kidney function after transplantation. No severe complication was revealed during follow-up period. We described the surgical technique used in the en bloc method to overcome various vascular anomalies and difficulties in choosing cannulation site and postoperative complications. En bloc transplantation of a horseshoe kidney is a useful strategy for patients with end-stage renal disease, and can provide favorable outcomes compared to the transplantation of a normal kidney.

Keyword

Kidney transplantation; Horseshoe kidney; En bloc kidney transplantation

MeSH Terms

Catheterization
Follow-Up Studies
Fused Kidney*
Humans
Kidney
Kidney Failure, Chronic
Kidney Transplantation
Korea*
Methods
Postoperative Complications
Transplants

Figure

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  Fig. 1 Deceased donor's CT scan. Image shows isthmus of horseshoe kidney consisting of renal parenchyma.

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  Fig. 2 (A) During the first donor's bench procedure, horseshoe kidney showed 5 arteries (white arrows) and 2 veins (white arrows) drained to graft aorta and vena cava. (B) In the third case, 2 arteries and 1 vein on each side were shown at back-table procedure.

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  Fig. 3 Photograghed and drawn images of each horseshoe kidney after all anastomosis was done. (A) Graft aorta and vena cava were seen in middle of graft kidney. (B) Graft kidney placed upside down because lower portion of kidney was too large to be put into pelvic cavity. (C) Graft kidney was placed on right side of abdominal cavity to make graft vasculature perpendicular to recipient's aorta and inferior vena cava.

Reference

1. Zipitis CS, Augustine T, Tavakoli A, Surange R, Agrawal A, Riad HN. Horseshoe kidney transplantation. Surgeon. 2003; 1:160–163. PMID: 15570753.

2. Stroosma OB, Scheltinga MR, Stubenitsky BM, Kootstra G. Horseshoe kidney transplantation: an overview. Clin Transplant. 2000; 14:515–519. PMID: 11127302.

3. Stroosma OB, Schurink GW, Smits JM, Kootstra G. Transplanting horseshoe kidneys: a worldwide survey. J Urol. 2001; 166:2039–2042. PMID: 11696702.

4. Nelson RP, Palmer JM. Use of horseshoe kidney in renal transplantation: technical aspects. Urology. 1975; 6:357–359. PMID: 1099770.

5. Pontinen T, Khanmoradi K, Kumar A, Kudsi H, Cheng Kung S, Chewaproug D, et al. Horseshoe kidneys: an underutilized resource in kidney transplant. Exp Clin Transplant. 2010; 8:74–78. PMID: 20199375.

6. Huser N, Geraurer KE, Novotny AR, Assfalg V, Stangl MJ. Successful living donor transplantation of a kidney with horseshoe malformation: extending the donor pool. Transpl Int. 2005; 18:761–762. PMID: 15910309.

7. Hau HM, Morgul HM, Uhlmann D, Thelen A, Fellmer P, Benckert C, et al. Horseshoe kidney for transplantation: technical considerations. Scand J Urol. 2013; 47:76–79. PMID: 22835080.

8. Stroosma OB, Smits JM, Schurink GW, de Boer J, Persijn GG, Kootstra G. Horseshoe kidney transplantation within the eurotransplant region: a case control study. Transplantation. 2001; 72:1930–1933. PMID: 11773891.

9. Uzzo RG, Hsu TH, Goldfarb DA, Taylor RJ, Novick AC, Gill IS. Strategies for transplantation of cadaveric kidneys with congenital fusion anomalies. J Urol. 2001; 165:761–765. PMID: 11176462.

10. Foster JT, Morrissey PE. Segmental renal ischemia following transplantation of horseshoe kidney as separate allografts. Case Rep Transplant. 2013; 2013:852127. PMID: 23476879.