Strategies for transplantation of cadaveric kidneys with congenital fusionanomalies

Purpose: The dire shortage of cadaveric kidneys has led to a gradual expans ion of donor criteria in the transplant community. The use of kidneys with anatomical fusion anomalies is uncommon and has not been well defined in th e literature. We evaluated the surgical strategies and postoperative outcom es of transplanting cadaveric kidneys with congenital fusion anomalies. Materials and Methods: Three cadaveric kidneys with congenital fusion anoma lies were procured and transplanted between May 1994 and November 1999. Non e of the 3 donors had any significant urological history. Al fusion anomali es were identified during the organ procurement process. Results: Anomalies included I L-shaped cross-fused ectopic and 2 horseshoe kidneys. All 3 kidneys were procured en bloc. One horseshoe kidney with a n arrow isthmus was split and the 2 kidneys were transplanted into separate r ecipients, while the other horseshoe kidney was transplanted en bloc into a single recipient. The L-shaped kidney was transplanted en bloc into I pati ent. All transplants were successful with a serum creatinine of 1.1 to 1.9 mg./dl. Conclusions: To our knowledge we present the initial case of transplantatio n of an L-shaped kidney. Cadaveric kidneys with congenital fusion anomalies may be transplanted successfully using various individual technical strate gies based on the specific renal anatomy. As such, these kidneys may be use d to maximize the increasingly inadequate donor pool.