Transplantation of a Pelvic Kidney with Multiple (Damaged) Vessels and a Short Ureter from a Controlled Non Heart Beating Donor

Background and Aims:

The severity of organ shortage places transplant surgeons in the difficult position ofdeciding whether to use or discard marginal donor kidneys. This case details the successful use of a pelvic kidney with a short ureter and multiple vessels from a controlled non heart beating donor and reviews relevant literature.

Case Report:

A 69 year old lady received the right kidney from a 48 year old female controlled non heart beating donor. The donor kidney had three arteries (one of which was damaged) on one aortic patch, and an extremely short (7cm), thin-walled and narrow lumen (2-3 mm) ureter, all of which combined to make the transplantation technically challenging and the postoperative course complicated. In the post transplantation period, there were difficulties in establishing adequate transplant drainage due to frequent nephrostomy tube and ureteric stent dislodgement, and sepsis. The patient was discharged home on day 62 with a glomerular filtration rate of 31 ml/min and a creatinine of 148 μmol/L, and these were 51 ml/min and 97 μmol/L nine months postoperatively.

Conclusions:

This case demonstrates that it is possible to extend the boundaries for accepting marginal kidneys for transplantation, after discussing the risks of the procedure with the patient. Ureteric stenting, intense postoperative monitoring of the transplant and early intervention in the event of ureteric complications must be applied to ensure success.Implantation of marginal donor kidneys with damaged or short ureters should be considered if a good renal function is likely.