#OxfordClinicalCase: Anastomosis of dual renal transplant ve
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Surgeons were provided with a right kidney from a 55-year-old male donation after a brain death donor who had died as a result of intracerebral hemorrhage. The kidney had a single renal artery with aortic patch and a single ureter but there were dual renal veins. The main hilar renal vein had a diameter of 12 mm, the lower polar vein had a diameter of 8 mm and the veins were separated by a distance of 4 cm. The veins had been divided at the level of the inferior vena cava; a caval tube had not been provided.

The recipient was a 47-year-old female with a body mass index of 28.5 m2/kg and end-stage renal failure secondary to chronic pyelonephritis. The kidney was implanted into the right iliac fossa. The main hilar renal vein was anastomosed end to side to the external iliac vein using 5/0 polypropylene and the renal arterial patch was anastomosed end to side to the external iliac artery using 5/0 polypropylene. The lower polar vein was controlled with a fine atraumatic vascular clamp and not anastomosed initially. On release of the arterial and venous clamps, the kidney appeared globally well perfused and some urine production was observed. Nonetheless, both the main hilar and lower polar veins were distended and felt congested. On-table Doppler ultrasound was performed by members of the surgical team. This confirmed that the kidney was globally perfused but the waveforms showed reversal of flow in diastole throughout the kidney.

The external iliac vein was clamped inferior to the upper renal vein anastomosis and at the inguinal ligament and the lower polar vein was then anastomosed end to side to the external iliac vein using 5/0 prolene. On clamp release the kidney’s appearance improved immediately and both renal veins became soft and easily compressible. A repeat intraoperative Doppler ultrasound examination demonstrated excellent perfusion of the whole kidney and a triphasic waveform with forward flow in diastole. These findings were confirmed in the recovery room by an experienced radiologist. The cold ischaemic time was 12 h 18 min and the anastomosis time was initially 32 min with a further 10 min for the lower polar venous anastomosis. The kidney had initial function and at 12 month follow-up the recipient’s serum creatinine was 103 mol/l.

Source: https://academic.oup.com/jscr/article/2020/9/rjaa310/5905429
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