Deceased and living donor renal allograft recovery
- Ron Shapiro, MD
Ron Shapiro, MD
- Professor of Surgery
- Surgical Director, Kidney/Pancreas Transplant Program
- Mount Sinai Hospital - Recanati Miller Transplantation Institute
- Section Editor
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
Until totally implantable bioartificial or laboratory-grown kidneys become available, transplant surgeons must retrieve kidneys from deceased or living donors. An enormous part of the success of renal transplantation is predicated on the technically perfect recovery of the kidney [1-3]. The technical aspects of deceased- and living-donor renal allograft recovery will be discussed here.
Most of the time, a number of different organs will be recovered from a single deceased donor, potentially including the heart, lungs, liver, pancreas, kidneys, and intestine [4,5]. The kidneys can be reliably predicted to be the last organs to be removed.
Technique — The deceased donor will have been given heparin and possibly phentolamine (to promote vasodilatation) prior to aortic cross clamping. Donor pretreatment with dopamine may decrease the requirement for dialysis after kidney transplantation . In a randomized, prospective study, for example, the administration of low-dose dopamine (4 mcg/kg per minute) for a median period of 344 minutes resulted in a decreased need for multiple dialyses posttransplant (25 versus 35 percent, 95% CI 0.35-0.83) . Thus, with respect to donor management, a low threshold should exist to initiate low-dose dopamine early in the donor transplant management.
Via a cannula placed in the distal aorta, the kidneys are kept cold by an in-situ flush with an intracellular type of preservation solution. In the United States, the most popular is the University of Wisconsin (UW; Viaspan) solution; however, there has been an increase over the past several years in the utilization of histidine-tryptophan-ketoglutarate (HTK) solution as an alternative. There is some evidence that the HTK and UW solutions provide similar patient and allograft survival rates . The kidneys are usually not seen or mobilized prior to aortic cross clamping as such manipulation can adversely affect the liver.
Once the thoracic and upper abdominal organs have been removed, the right colon and distal small bowel are mobilized medially and superiorly, and the right kidney is exposed. The right kidney is then mobilized medially, with Gerota's fascia, from the retroperitoneum. The left colon is then mobilized medially and superiorly, and the lower splanchnic nerves are divided. The left kidney, again with Gerota's fascia, is mobilized medially.
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