- Email: [email protected]
Technic for lengthening the right renal vein of cadaver donor kidneys
Technic for Lengthening the Right Renal Vein of Cadaver Donor Kidneys
Robert J. Carry, MD, Iowa City, Iowa Stephen E. Kelley, Iowa City, Iowa
In our Transplantation Center, we have used the en bloc technic of organ removal and have perfused kidneys through the aorta, which prevents any damage to small renal arteries by cannula tips. In addition, subsequent anastomosis of a patch of aorta with more than one renal artery to the recipient’s external iliac artery is preferable to suturing small arteries individually. The technic described herein of lengthening the right renal vein is an added benefit of the en bloc removal of kidneys. Commonly, the right renal vein is extremely short, particularly if it has been transected distal to its junction with the inferior vena cava. Anastomosis of ti short (1 or 2 cm) renal vein to the recipient’s iliac vein can be difficult, and after completion of the anastomosis, placement of the transplanted kidney in its most ideal position within the iliac fossa is sometimes not possible due to the inadequate length of vein. Technic
The left kidney is removed with a single cuff of vena cava, as shown in Figure 1. The venotomy in the vena cava is then extended to open the vena cava just above the right renal vein. The long venotomy is closed with a running vascular suture while the kidney is immersed in iced saline solution. The desired length of vena cava is selected, and any excess is removed. The inferior vena cava is then sutured to the iliac vein. Utilization of this technic eliminates the problem of the short right renal vein.
From the Department of Surgery, University of Iowa College of Medicine, Iowa City, Iowa. Reprint requests should be addressed to Robert J. Corry, MD, Transplantatlon Service, University of Iowa College of Medicine, Iowa (Xy, Iowa 52242.
vohlme 135, June 1978
Figure 1. A, horizontal solld lines across the vena cava and aorta show extent of vessels removed w/th the en bloc technic. Dotted lines on vena cava show how vena cava k divided to provkte maxlmum length of both right ahd left renal veins. 6, left kidney is removed, showing /ong veno tomy of vend cava..C, venotomyts closed whlie kidney is immersed In Iced saline solution. Length is thus added to the right renal vein by utilizing the Inferior vena cava.
Summary
As the need for cadaver kidneys for transplantation has increased, and regional and national sharing systems have developed, kidneys have been harvested by retrieval teams in hospitals and communities away from the Transplantation Center. Removal of kidneys by the en bloc technic not only ensures the preservation of multiple arteries, but permits creation of a right renal vein of adequate length.
867
Robert J. Carry, MD, Iowa City, Iowa Stephen E. Kelley, Iowa City, Iowa
In our Transplantation Center, we have used the en bloc technic of organ removal and have perfused kidneys through the aorta, which prevents any damage to small renal arteries by cannula tips. In addition, subsequent anastomosis of a patch of aorta with more than one renal artery to the recipient’s external iliac artery is preferable to suturing small arteries individually. The technic described herein of lengthening the right renal vein is an added benefit of the en bloc removal of kidneys. Commonly, the right renal vein is extremely short, particularly if it has been transected distal to its junction with the inferior vena cava. Anastomosis of ti short (1 or 2 cm) renal vein to the recipient’s iliac vein can be difficult, and after completion of the anastomosis, placement of the transplanted kidney in its most ideal position within the iliac fossa is sometimes not possible due to the inadequate length of vein. Technic
The left kidney is removed with a single cuff of vena cava, as shown in Figure 1. The venotomy in the vena cava is then extended to open the vena cava just above the right renal vein. The long venotomy is closed with a running vascular suture while the kidney is immersed in iced saline solution. The desired length of vena cava is selected, and any excess is removed. The inferior vena cava is then sutured to the iliac vein. Utilization of this technic eliminates the problem of the short right renal vein.
From the Department of Surgery, University of Iowa College of Medicine, Iowa City, Iowa. Reprint requests should be addressed to Robert J. Corry, MD, Transplantatlon Service, University of Iowa College of Medicine, Iowa (Xy, Iowa 52242.
vohlme 135, June 1978
Figure 1. A, horizontal solld lines across the vena cava and aorta show extent of vessels removed w/th the en bloc technic. Dotted lines on vena cava show how vena cava k divided to provkte maxlmum length of both right ahd left renal veins. 6, left kidney is removed, showing /ong veno tomy of vend cava..C, venotomyts closed whlie kidney is immersed In Iced saline solution. Length is thus added to the right renal vein by utilizing the Inferior vena cava.
Summary
As the need for cadaver kidneys for transplantation has increased, and regional and national sharing systems have developed, kidneys have been harvested by retrieval teams in hospitals and communities away from the Transplantation Center. Removal of kidneys by the en bloc technic not only ensures the preservation of multiple arteries, but permits creation of a right renal vein of adequate length.
867