Safe and effective elongation of a short graft and multiple renal veins using the gonadal vein (cylindrical technique) in living donor kidney transplantation

Abstract

Background: The use of laparoscopy is increasing in various surgical disciplines, including living donor kidney transplant (LDKT). In laparoscopic transplants, vessel length of the donor kidneys often falls short. This makes anastomosis to the recipient's external iliac vein difficult, which may cause problems when blood circulation reconstruction is required. Renal vein elongation (RVE) is often needed, but the available materials may fall short in terms of post-transplant vessel function. Objective and methods: We aimed to determine whether the gonadal vein was a viable option for RVE in LDKT. We therefore performed LDKT in three cases wherein RVE was performed using the gonadal vein. We used the cylindrical method wherein the donor's gonadal vein was shaped into a cylinder, and the vessel was extended end-to-end with the renal vein. Results: All cases showed immediate graft function after surgery. The total ischemic time was 151, 168, and 169 min in cases 1, 2, and 3, respectively. The serum creatinine levels at discharge were 0.98 mg/dL, 2.07 mg/dL, and 1.16 mg/dL in cases 1, 2, and 3, respectively. None of the patients developed any complications during their hospital stay. Conclusion: Since the renal vein was extended using a gonadal vein, vessel suturing with the external iliac vein became easier; as a result, bleeding and outflow block could be prevented.

Keywords

• Kidney transplantation
• Gonadal vein
• Laparoscopic donor nephrectomy
• Cylindrical technique