Abstract
Abstract
Purpose of Review
Advances in preservation and transplantation techniques have made renal autotransplantation (RA) a modality that can be utilized in complex renovascular diseases (renal artery aneurysms), high ureteric injuries, chronic kidney pain, as well as conventionally unresectable renal tumours. In the current review, we present the Oxford experience, the only UK commissioned centre to perform RA for complex renal cell cancers, and review the published RA experience from other UK centres.
Recent Findings
The evidence and literature generated from the RA experience in the UK are largely limited to case reports. The main indications reported for performing RAs include renovascular disease, ureteral pathology and prophylaxis from radiation.
Summary
Renal autotransplantation is an option for a highly select group of patients. It has short-term and long-term complication rates comparable to those of other major operations. Extensive preoperative counselling in conjunction with multidisciplinary professionals is of utmost importance for informed decision making.
Publisher
Springer Science and Business Media LLC
Reference11 articles.
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4. •• Cowan NG, Banerji JS, Johnston RB, Duty BD, Bakken B, Hedges JC, et al. Renal autotransplantation: 27-year experience at 2 institutions. J Urol. 2015; 194(5): 1357–61 This is a retrospective, observational study of 51 consecutive patients who underwent 54 renal autotransplants. The commonest indications reported were loin pain hematuria syndrome/chronic kidney pain in 31.5% of cases, ureteral stricture in 20.4% and vascular anomalies in 18.5%. Autotransplantation of a solitary kidney was performed in 5 patients. The authors reported no significant difference between preoperative and postoperative plasma creatinine (p = 0.74). However, early high-grade complications (grade IIIa or greater) developed in 14.8% of patients and 12.9% experienced late complications of any grade. Of patients who underwent autotransplantation for chronic kidney pain 35% experienced recurrence and 2 underwent transplant nephrectomy.
5. •• GHJ M. Renal cell cancer: bench surgery and autotransplantation for complex localised disease. European Urology Supplements. 2007;6(8):544–8 This is the largest autotransplantation series for complex RCC and includes 36 prospective cases that involved bench surgery and autotransplantation. Surgical complications were few, but significant: one perioperative death after 5 days due to myocardial infarction, one kidney lost due to transplantation failure, and one patient was on hemodialysis for 3 weeks until complete functional recovery. The follow-up period was 2.8 years (median); one patient had distant metastasis and one patient had a recurrent tumour in his kidney after 13 mo. The author concludes that there is a clear need for strict inclusion criteria such as an imperative indication and organ-confined stages, a multidisciplinary team approach, suitable infrastructure, and experience in major surgical procedures. If these criteria are met, bench surgery followed by autotransplantation is recommended as a valuable and safe last resort.
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