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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 2  |  Page : 408-409
Use of a pelvic kidney for living transplantation


1 Department of Nephrology, Hedi Chaker Hospital, Sfax, Tunisia
2 Department of Urology, CHU Habib Bourguiba, Sfax, Tunisia

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Date of Web Publication11-Mar-2014
 

How to cite this article:
Yaich S, Charfeddine K, Zaghdhane S, Toumi S, Bahloul A, Mhiri MN, Hachicha J. Use of a pelvic kidney for living transplantation. Saudi J Kidney Dis Transpl 2014;25:408-9

How to cite this URL:
Yaich S, Charfeddine K, Zaghdhane S, Toumi S, Bahloul A, Mhiri MN, Hachicha J. Use of a pelvic kidney for living transplantation. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Nov 12];25:408-9. Available from: http://www.sjkdt.org/text.asp?2014/25/2/408/128596
To the Editor,

Individuals with ectopic kidneys located in the bony pelvis (pelvic kidneys) have up to now been excluded from donating, because pelvic kidneys are usually small and may have anomalous vascular supplies as well as com­plex urinary drainage systems. [1] We report the use of a pelvic kidney for living-related renal transplantation in a 58-year-old man with end-stage renal disease secondary to an unknown nephropathy presented for pre-emptive kidney transplantation. The donor was his 25-year-old son. His physical examination was unremark­able. His measured creatinine clearance was between 125 and 130 mL/min, and his urina­lysis was negative for protein and blood. Ultra­sound examination showed an ectopic left-sided kidney, while the right kidney was in place and normally sized. Renal scintigraphy indicated that the left kidney provided 42% of his overall renal function. Renal angiography demonstrated the presence of three renal arte­ries emerging just above the bifurcation of the aorta and a unique renal vein. Intravenous pye-logram demonstrated a single left-sided ureter. Transplantation was performed in February 2006. The donor nephrectomy was performed through a transperitoneal louver midline inci­sion. The main artery had a good caliber and was anastomosed end-to-side to the recipient external iliac artery. The two other tiny arteries were sacrificed. The vein was also anasto­mosed end-to-side to the recipient external iliac vein. The ureter was stented using a tun­neled Lich-gregoire technique. The post-operative course was uneventful, with an immediate urine output. His creatinine fell from 600 μmol /L to 150 umol/L by the sixth post-operative day. Currently, six years after his transplan­tation, the patient has a stable creatinine at 140 μmol/L, no abnormalities on urinalysis and a well-controlled blood pressure on monotherapy. No further medical problems were noted du­ring his routine follow-up.

An ectopic kidney is a rare congenital ano­maly that occurs when the kidney fails to ascend to its normal position. Its incidence is estimated to be one in 1000 autopsies. [1] Pre­vious reports described successful transplan­tation of ectopic kidneys. [2],[3],[4],[5],[6],[7] However, these donors should have extensive investigations of the renal vasculature and anatomy variation using angiography or spiral computed tomo­graphy. Intravenous pyelography should also be performed to detect urinary tract abnor­mality. Similarly, nuclear renography is neces­sary to assess the renal function of each kid­ney. A proper surgical technique is also neces­sary to ensure a successful transplantation of these ectopic kidneys. Certainly, the use of these kidneys will not increase significantly the donor pool, but it represents an alternative for our patients who have access more easily for living transplantation.

 
   References Top

1.Dretler SP, Olssen C, Pfister RC. The anato­mic, radiologic and clinical characteristics of the pelvic kidney: An analysis of 86 cases. J Urol 1971;105:623-7.  Back to cited text no. 1
    
2.Luke PP, Mc Alister VC, Jevnikar AM, et al. Use of a pelvic kidney for living transplan­tation: Case report and review of the literature. Am J Transplant 2003;3:235-8.  Back to cited text no. 2
    
3.Bacharach MD, Tinley NI. Use of an ectopic pelvic donor kidney for transplantation. Transplant Proc 1984;16:1663-5.  Back to cited text no. 3
    
4.Kumar A, Dubey D, Verma BS, Kathuria M, Bansal P. Live donation of ectopic kidneys: A feasible option under compelling circumstances. J Urol 2001;165:505-6.  Back to cited text no. 4
    
5.Grogan EL, Nylander WA, Shaffer D. Living related Transplantation of an ectopic pelvic kidney. Transplantation 2004;77:953.  Back to cited text no. 5
[PUBMED]    
6.Spanos PK, Well R III, Simmons RL, Najarian JS. Successful transplantation of ectopic kid­neys from living related donors. Am J Surg 1976;131:360-2.  Back to cited text no. 6
    
7.Papanikolaou V, Giakoustidis D, Antoniadis N, Ouzounidis N, Takoudas D, Antoniadis A. Living-related transplantation of an ectopic pelvic kidney. Int J Urol 2007;14:357-9.  Back to cited text no. 7
    

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Correspondence Address:
Soumaya Yaich
Department of Nephrology, Hedi Chaker Hospital, Sfax
Tunisia
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DOI: 10.4103/1319-2442.128596

PMID: 24626014

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