Manual Manipulation and Ex Vivo Flexible Ureteroscopic Lithotripsy to Salvage Deceased Donor Kidneys with Renal Stones: A Case Series

Abstract

Background: Nephrolithiasis is a relative contraindication to kidney donation. This study aimed to determine the feasibility and effectiveness of a surgical technique that can salvage a deceased donor kidney with renal stone, which involves manual manipulation of the kidney harvested from a deceased donor combined with flexible ureteroscopic lithotripsy (MM-FURSL) Case presentation: A total of 9 kidneys were harvested from 6 deceased patients. The recipients (66.7% female; mean age 43.9 ± 12.2 years) previously received dialysis for a mean duration of 2.6 years before receiving renal transplantation with MM-FURSL. The number of stones in donor kidneys ranged between 1 – 4 (mean max. diameter 15.1 ± 10.6 mm; mean CT value 942.0 ± 106.6 HU). Mean duration of warm and cold ischemia for the donor kidneys were 5 min and 480 ± 108.2 min respectively. The mean total operative duration was 57.0 ± 63.4 min. The first patient that underwent MM-FURSL used a reusable FURS that was found to be damaged intraoperatively. Her operative time and donor cold ischemia duration was the longest. She was the only patient that suffered from acute tubular necrosis (ATN) but creatine levels recovered within 3 weeks. No other complication was observed during a mean follow-up of 11.7 ± 8.2 months. Conclusion: MM-FURSL is an effective method to remove renal stones in donor kidneys. Short-term outcomes were favorable, which may make a feasible method to expand the pool of donor kidneys by salvaging donor kidneys with nephrolithiasis. Prolonged cold ischemia may be associated with ATN and should be avoided.