Perin Luca, Romano Maurizio, Bona Enrico Dalla, Finotti Michele, Iacomino Alessandro, Mangino Margherita, Sergi Filomena, Maffei Rossana, Nordio Maurizio, Zanatta Paolo, Zanus Giacomo
Chirurgia Generale 2, Ca' Foncello Hospital, Treviso, Italy.
Chirurgia Generale 2, Ca' Foncello Hospital, Treviso, Italy.
Transplant Proc. 2025 Jun 19. doi: 10.1016/j.transproceed.2025.05.010.
The use of marginal kidney donors with congenital morphological anomalies, such as the "horseshoe" kidney, presents itself as a solution to expand the donor pool. The vascular and urinary anatomy of the horseshoe kidney is complex. These patients are more frequently affected by hydronephrosis, vesicoureteral reflux, urinary tract infections, and urolithiasis. The horseshoe kidney can be transplanted "en bloc" or as a single kidney after "splitting." A 54-year-old patient with end-stage renal failure, on hemodialysis for 4 years, was transplanted with a "horseshoe" graft from a deceased cardiac death (DCD) III Maastricht-type donor. The "preoperative" computed tomography (CT) documented the presence of a "horseshoe" kidney, non-divisible due to the presence of a shared lower polar renal artery between both kidneys. There were no anomalies in the collecting systems except for a slight dilation of the right renal pelvis. The distal side of the inferior vena cava was anastomosed end-to-side with the external iliac vein. The left common iliac artery of the donor was sutured end-to-side with the external iliac artery. The ureters were implanted separately after the placement of the Double J (DJ) stents. There were no perioperative complications. Immunosuppressive therapy was induced with ATG and subsequently tacrolimus and mycophenolate mofetil were introduced. In 4 months of follow-up, the patient developed a lymphocele that was drained percutaneously. The DJ stents were removed after 3 months. The donor with a horseshoe kidney, in the absence of a urological pathological history, can be considered for transplantation even in a DCD setting by planning an appropriate preoperative strategy.
使用具有先天性形态异常的边缘性肾供体，如“马蹄形”肾，是扩大供体库的一种解决方案。马蹄形肾的血管和泌尿系统解剖结构复杂。这些患者更常受到肾积水、膀胱输尿管反流、尿路感染和尿路结石的影响。马蹄形肾可以“整块”移植，也可以在“劈开”后作为单个肾脏移植。一名54岁的终末期肾衰竭患者，已接受4年血液透析，接受了来自一名脑死亡（DCD）III型马斯特里赫特标准供体的“马蹄形”肾移植。“术前”计算机断层扫描（CT）显示存在“马蹄形”肾，由于双肾之间存在共同的下极肾动脉而无法分割。除右肾盂略有扩张外，集合系统无异常。下腔静脉远端与髂外静脉端侧吻合。供体的左髂总动脉与髂外动脉端侧缝合。在放置双J（DJ）支架后，输尿管分别植入。无围手术期并发症。免疫抑制治疗采用抗胸腺细胞球蛋白诱导，随后引入他克莫司和霉酚酸酯。在4个月的随访中，患者出现了经皮引流的淋巴囊肿。3个月后取出DJ支架。即使在DCD情况下，对于没有泌尿系统病理病史的马蹄形肾供体，通过制定适当的术前策略也可考虑进行移植。
