Indication, surgical technique and outcome of orthotopic renal transplantation

Purpose: We review the indication, surgical technique and outcome of orthot opic renal transplantation. Materials and Methods: The medical records of 1,000 patients who underwent renal transplantation at our institution between August 24, 1993 and August 1, 2000, as well as orthotopic renal transplantation were reviewed. Results: Orthotopic renal transplantation was performed in 4 males and I fe male with severe iliac atherosclerosis or retained bilateral iliac fossa ki dney transplant. Mean patient age was 56 years. There were 2 patients who r eceived kidneys from living related donors, and 3 underwent cadaveric renal transplantation. Left orthotopic renal transplantation was successful in 4 cases, and I was converted to iliac fossa renal transplant because of a pu lseless splenic artery and renal artery thrombosis after native renal endar terectomy. Orthotopic. renal revascularization was done with splenic artery in 2, native renal artery in 2 and left renal vein in all 4 patients. Urin ary tract reconstruction was performed with stented (2) or nonstented (2) u reteroureterostomy. Antibody induction, purine antagonists, calcineurin inh ibitors and glucocorticoids were used for immunosuppression. Mean preoperat ive and 1-month postoperative serum creatinine was 7.9 and 1.3 mg./dl., res pectively. Patient and graft survival was 100% during followup, which range d from 6 months to 5 years. Conclusions: Despite the technical challenges, orthotopic renal transplanta tion in patients with unsuitable pelvic vessels can result in excellent pat ient and graft survival.