Outcomes of kidney autotransplantation technique in the treatment of different vascular disorders: an updated narrative review

Abstract

INTRODUCTION: Kidney autotransplantation (KAT) is a versatile surgical technique used to treat multiple diseases affecting the kidney. This procedure allows the reconstruction of the renal artery or vein with optimal surgical exposure reducing warm ischemia time compared to open direct repair. Although infrequently reported nowadays and despite the growing use of endovascular treatments, KAT still has a place in treating complex kidney vascular conditions. METHODS: We performed a literature review using the MEDLINE®, SCOPUS, and Web of Science databases with the combination of the terms: “kidney autotransplantation,” “renal artery,” “renal vein,” “aorta,” “aneurysm,” and “nutcracker syndrome.” All relevant English-language studies published between January 1990 and June 2022 reporting the outcomes of the KAT technique in vascular disorders were included. RESULTS: A total of 32 articles were included. Ex-vivo repair and KAT is widely described in treating renal artery aneurysms (RAA), with a reported technical success rate of 99.9%, a complication rate ranging from 6.9 to 9.4%, and a graft loss rate of up to 4.1%. The use of the laparoscopic technique for harvesting the kidney was variable throughout the series published, and heterotopic KAT was performed in most treated patients. Ex-vivo repair and KAT was successfully used after failed endovascular therapy and is a viable option in women of childbearing age with bilateral complex RAA. Concerning renal artery stenosis associated with different etiologies (fibromuscular dysplasia, Takayasu's arteritis, and neurofibromatosis type 1), significant reduction of blood pressure and the number of anti-hypertensive drugs have been reported in most patients after KAT. Results of arterial hypertension improvement associated with RAA after KAT are more variable. The use of KAT in treating nutcracker syndrome is reported with good results, even after left renal vein transposition or venous stenting failure. Other reports exist on the successful use of KAT for treating renal vein aneurysms and as an adjunct in open surgical or hybrid aortic reconstructions. CONCLUSION: Renal autotransplantation is a useful technique in the treatment of kidney vascular disorders with good overall results reported in the literature. It may be an essential adjunct in open surgical or hybrid treatments for abdominal and thoracoabdominal aortic diseases. Defining the patients who would benefit from this technique as a preferential treatment choice in different renal vessel disorders would be necessary.

Keywords

• Kidney autotransplantation
• Renal Artery Aneurysms
• Renovascular hypertension
• Nutcracker syndrome
• Renal vein Aneurysm