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POINT OF TECHNIQUE
Year : 2000  |  Volume : 16  |  Issue : 2  |  Page : 172-174
 

Is it safe to take vena cava cuff with right donor nephrectomy in live related renal transplant?


Department of Urology and Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Correspondence Address:
Anant Kumar
Department of Urology & Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Donor; Nephrectomy; Inferior Vena Cava; Kidney; Transplant.


How to cite this article:
Chaurasia D, Kumar A, Mandhani A, Srivastava A, Bhandari M. Is it safe to take vena cava cuff with right donor nephrectomy in live related renal transplant?. Indian J Urol 2000;16:172-4

How to cite this URL:
Chaurasia D, Kumar A, Mandhani A, Srivastava A, Bhandari M. Is it safe to take vena cava cuff with right donor nephrectomy in live related renal transplant?. Indian J Urol [serial online] 2000 [cited 2019 Aug 24];16:172-4. Available from: http://www.indianjurol.com/text.asp?2000/16/2/172/22230



   Existing Problem Top


Right renal vein is smaller in length and its wall is very thin, especially at its junction with inferior vena cava (IVC). If right renal vein is divided at its junction with vena cava, anastomosis in recipient is not easy due to its short length as well as tearing of the thin part of the vein. To avoid tear if the thin part of the vein is removed it causes further shortening of its length, thus making anas­tomosis more difficult. If a cuff of vena cava is taken along with right renal vein it increases the length of the renal vein as well as provides a thick and sturdy wall of IVC for anastomosis and thus reducing the problems.

We used this technique in 132 patients who underwent live related renal transplant between January 1990 to April 1999. The main indication for right donor nephrectomy was multiple renal arteries on left side (90.4%), while a single renal artery on right side.


   Methods & Results Top


All donor nephrectomies were performed by extraperi­toneal flank approach with subperiosteal excision of the 12th rib. IVC was mobilized after ligating the gonadal and lumbar vein if encountered during the dissection. The junc­tion of right renal vein and vena cava was mobilized com­pletely. Renal artery was dissected from behind and di­vided after applying a clamp. A Satinsky clamp was ap­plied on the vena cava to occlude it partially and a 3-5mm cuff of vena cava was excised along with right renal vein. The inferior vena cava was repaired with 4/0 prolene. Cuff of the IVC was anastomosed with external iliac vein end to side using 5/0 prolene. However, one should not pull the kidney while performing anastomosis as it may cause tear at the junction of IVC cuff and renal vein which is very thin.

We have performed 132 right donor nephrectomies with­out any significant complications. However, 12.2% pa­tients had post operative minor complications like wound infections (6%), UTI (3%), collection in renal fossa (1.2%) and pleural injury in 2.0%.


   Comparison with Other Methods Top


The left kidney is usually preferred in live related renal transplant because it has a longer vein which facilitates anastomosis in recipients. [1] Few millimeters of vena cava cuff with the right renal vein increases its length and helps in anastomosis with recipient vein as it becomes easy and safe. [2] This practice is commonly performed in cadaveric renal transplants, whereas it is not popular in living re­lated renal transplant due to the potential risk of IVC cuff excision and the possibility of bleeding. There was no short or long term problem associated with partially clamping the IVC as well as the repair of IVC defect. It is easier to repair the defect than to anastomose a small renal vein stump.


   Advantages Top


IVC cuff increases the length of the right renal vein as well as it provides a relatively tough tissue for anastomo­sis. This extra length makes the anastomosis easy, quick and safe.[Figure 1],[Figure 2],[Figure 3]

 
   References Top

1.Walker TG, Geller SC, Delmonico FL. Waltman AC, Athanasoulis CA. Donor renal angiography: lts influence on the decision to use the right or left kidney. AJR 1988; 151:1149-1151.  Back to cited text no. 1    
2.Yang SC, Seong DH, Kim YS, Park K. Living donor nephrecto­mies - right side- intraoperative assessment of right renal vascular pedicle in 112 cases. Yonsei Med J 1993; 34:175-178.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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