Outcomes of kidney autotransplantation technique in the treatment of different vascular disorders: an updated narrative review
Keywords:Kidney autotransplantation, Renal Artery Aneurysms, Renovascular hypertension, Nutcracker syndrome, Renal vein Aneurysm
INTRODUCTION: Kidney autotransplantation (KAT) is a versatile surgical technique used to treat multiple diseases affecting the kidney. This procedure allows the reconstruction of the renal artery or vein with optimal surgical exposure reducing warm ischemia time compared to open direct repair. Although infrequently reported nowadays and despite the growing use of endovascular treatments, KAT still has a place in treating complex kidney vascular conditions.
METHODS: We performed a literature review using the MEDLINE®, SCOPUS, and Web of Science databases with the combination of the terms: “kidney autotransplantation,” “renal artery,” “renal vein,” “aorta,” “aneurysm,” and “nutcracker syndrome.” All relevant English-language studies published between January 1990 and June 2022 reporting the outcomes of the KAT technique in vascular disorders were included.
RESULTS: A total of 32 articles were included. Ex-vivo repair and KAT is widely described in treating renal artery aneurysms (RAA), with a reported technical success rate of 99.9%, a complication rate ranging from 6.9 to 9.4%, and a graft loss rate of up to 4.1%. The use of the laparoscopic technique for harvesting the kidney was variable throughout the series published, and heterotopic KAT was performed in most treated patients. Ex-vivo repair and KAT was successfully used after failed endovascular therapy and is a viable option in women of childbearing age with bilateral complex RAA.
Concerning renal artery stenosis associated with different etiologies (fibromuscular dysplasia, Takayasu's arteritis, and neurofibromatosis type 1), significant reduction of blood pressure and the number of anti-hypertensive drugs have been reported in most patients after KAT. Results of arterial hypertension improvement associated with RAA after KAT are more variable.
The use of KAT in treating nutcracker syndrome is reported with good results, even after left renal vein transposition or venous stenting failure. Other reports exist on the successful use of KAT for treating renal vein aneurysms and as an adjunct in open surgical or hybrid aortic reconstructions.
CONCLUSION: Renal autotransplantation is a useful technique in the treatment of kidney vascular disorders with good overall results reported in the literature. It may be an essential adjunct in open surgical or hybrid treatments for abdominal and thoracoabdominal aortic diseases. Defining the patients who would benefit from this technique as a preferential treatment choice in different renal vessel disorders would be necessary.
Hardy JD. High ureteral injuries. Management by autotransplantation of the kidney. JAMA. 1963;184:97-101.
Alameddine M, Moghadamyeghaneh Z, Yusufali A, Collazo AM, Jue JS, Zheng I, et al. Kidney Autotransplantation: Between the Past and the Future. Curr Urol Rep. 2018;19:7.
Ruiz M, Hevia V, Fabuel JJ, Fernandez AA, Gomez V, Burgos FJ. Kidney autotransplantation: long-term outcomes and complications. Experience in a tertiary hospital and literature review. Int Urol Nephrol. 2017;49:1929-35.
Ramouz A, Hafezi M, Ali-Hasan-Al-Saegh S, Shafiei S, Dezfouli SA, Probst P, et al. Renal Artery Repair with Kidney Autotransplantation for Renal Artery Aneurysms. Eur J Vasc Endovasc Surg. 2022;63:732-42.
Contarini E, Takagi K, Kimenai H, Ijzermans JNM, Furian L, Rigotti P, et al. Kidney Autotransplantation for Renal Artery Aneurysm: Case Series and a Systematic Review. Ann Vasc Surg. 2021;77:349 e5- e18.
Machado M, Machado R, Almeida R. Renal Autotransplantation for The Treatment of Renal Artery Aneurysm. Ann Vasc Surg. 2021;79:226-232.
Dezfouli SA, Ramouz A, Demirel S, Chang DH, Mehrabi A, Bockler D. Multimodal Repair of Renal Artery Aneurysm - 10-year Single Center Experience. Ann Vasc Surg. 2022;82:303-13.
Pomy B, Glousman B, Macsata R. Management of bilateral renal artery aneurysms with laparoscopic nephrectomy, ex vivo reconstruction, and autotransplantation in a woman planning pregnancy. J Vasc Surg Cases Innov Tech. 2020;6:126-8.
Mendes DA, Machado R, Veiga C, Veterano C, Rocha H, Castro J, et al. Bilateral kidney autotransplantation as a solution for multiple aneurysms of the renal arteries branches: a case report. Angiol Cir Vasc. 2022;17:319-24.
SmithM,LazarA,MorrisseyN,RatnerL.Laparoscopicnephrectomywith ex vivo repair of aneurysm and autotransplantation. J Vasc Surg Cases Innov Tech. 2020;6:24-6.
Zhao K, Obayemi J, Lim MAC, Wang G, Naji A. Ex-Vivo Repair of Complex Hilar Renal Artery Aneurysms and Auto-Transplantation of Solitary Kidney. Ann Vasc Surg. 2021;74:523 e9- e13.
Jain P, Naik AL, Ansari A, Kaman L, Tandup C, Gorsi U, et al. Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms. J Vasc Bras. 2021;20:e20210012.
Sobrinho G, Ministro A, Silva A, Pedro L. Ex-vivo Surgical Repair of a Renal Artery Aneurysm with Kidney Autotransplantation. Acta Med Port. 2020;33:688-91.
Morosanu C, Burlacu A, Miron A, Popa IV, Covic A. Treating a thrombotic giant dissecting renal artery aneurysm through ex-vivo vascular reconstructive surgery followed by kidney reimplantation. Rev Cardiovasc Med. 2021;22:175-9.
van Rooden CJ, van Baalen JM, van Bockel JH. Spontaneous dissection of renal artery: long-term results of extracorporeal reconstruction and autotransplantation1. J Vasc Surg. 2003;38:116-22.
Corbetta JP, Duran V, Burek C, Weller S, Sager C, Dingevan R, et al. Renal autotransplantation for the treatment of renovascular hypertension in the pediatric population. J Pediatr Urol. 2011;7:378-82.
Li FD, Ji ZG, Liu CW, Shao J, Xie Y, Zheng YH. Orthotopic renal autotransplantation for young-onset and medical treatment-requiring complex renovascular hypertension. J Renin Angiotensin Aldosterone Syst. 2018;19:1470320318789861.
Sevmis S, Karakayali H, Boyvat F, Aytekin C, Haberal M. Renal autotransplantation for the treatment of complex renovascular hypertension. Transplant Proc. 2006;38:3412-5.
Scott T, Venuthurupalli SK. Kidney autotransplantation as a treatment for resistant hypertension due to renal artery stenosis: A case report and review of the literature. Clin Nephrol Case Stud. 2022;10:1-5.
Zhang H, Li FD, Ren HL, Zheng YH. Aortic bypass and orthotopic right renal autotransplantation for midaortic syndrome: a case report. BMC Surg. 2014;14:86.
Poupalou A, Salomon R, Boudjemline Y, Allain-Launay E, Aigrain Y, Chardot C. Aortic bypass and bilateral renal autotransplantation for mid-aortic syndrome. Pediatr Nephrol. 2013;28:1871-4.
Ali-El-Dein B, Osman Y, Shehab El-Din AB, El-Diasty T, Mansour O, Ghoneim MA. Anterior and posterior nutcracker syndrome: a report on 11 cases. Transplant Proc. 2003;35:851-3.
Salehipour M, Rasekhi A, Shirazi M, Haghpanah A, Jahanbini S, Eslahi SA. The role of renal autotransplantation in treatment of nutcracker syndrome. Saudi J Kidney Dis Transpl. 2010;21:237-41.
Xu D, Liu Y, Gao Y, Zhang L, Wang J, Che J, et al. Management of renal nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vivo autograft repair and autotransplantation: a case report and review of the literature. J Med Case Rep. 2009;3:82.
Decaestecker K, Van Parys B, Van Besien J, Doumerc N, Desender L, Randon C, et al. Robot-assisted Kidney Autotransplantation: A Minimally Invasive Way to Salvage Kidneys. Eur Urol Focus. 2018;4:198-205.
Miro I, Serrano A, Perez-Ardavin J, March JA, Polo A, Conca MA, et al. Eighteen years of experience with pediatric nutcracker syndrome: the importance of the conservative approach. J Pediatr Urol. 2020;16:218 e1- e6.
Bath NM, Al-Qaoud T, Williams DH, Sollinger HW, Redfield RR, 3rd. Renal autotransplantation results in pain resolution after left renal vein transposition. J Vasc Surg Venous Lymphat Disord. 2019;7:739-41.
Harkrader L, Alwatari Y, Daisuke I, Christanson J, Khan A, Bhati C. Robotic- assisted renal autotransplant as a novel treatment option for nutcracker syndrome. J Surg Case Rep. 2021;4:31-34
Avgerinos ED, Saadeddin Z, Humar R, Salem K, Singh M, Hager E, et al. Outcomes of left renal vein stenting in patients with nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2019;7:853-9.
Ozyuksel A, Aktas S, Calis E, Erol C, Sevmis S. Ex Vivo Resection and Renal Autotransplantation for the Treatment of a Large Renal Vein Aneurysm Causing Recurrent Pulmonary Embolism and a Coexisting Vascular Malformation: A Case Report. Vasc Endovascular Surg. 2016;50:415-20.
Espinosa G, Grochowicz L, Pascual I, Lavilla J, Olavide I, Hernandez MD, et al. Renal autotransplant for subsequent endovascular exclusion of the thoracoabdominal aorta. Ann Vasc Surg. 2013;27:974 e1-6.
Rana YP, Gupta SK, Singh DV, Bedi VS, Pathak K, Pradhan AA, et al. Renal autotransplantation as savior in hybrid surgery for aortic aneurysm repair. Urol Int. 2012;89:480-2.
Gazzola V, Spinella G, Mambrini S, Del Pizzo R, Mura MA, Palombo D, et al. Kidney Preservation Using Renal Heterotopic Autotransplantation during Fenestrated Endovascular Aortic Repair for Complex Residual Type-A Aortic Dissection. Ann Vasc Surg. 2019;58:385 e1- e6.
Min EK, Kim YH, Han DJ, Han Y, Kwon H, Choi BH, et al. Renal autotransplantation in open surgical repair of suprarenal abdominal aortic aneurysm. Ann Surg Treat Res. 2015;89:48-50.
Uehara A, Suzuki T, Hase S, Sumi H, Hachisuka S, Fujimoto E, et al. Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report. BMC Nephrol. 2019;20:160.
Coleman DM, Stanley JC. Renal artery aneurysms. J Vasc Surg. 2015;62(3):779-85.
Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020;72:3S-39S.
Rundback JH, Rizvi A, Rozenblit GN, Poplausky M, Maddineni S, Crea G, et al. Percutaneous stent-graft management of renal artery aneurysms. J Vasc Interv Radiol. 2000;11:1189-93.
Ananthan K, Onida S, Davies AH. Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines. Eur J Vasc Endovasc Surg. 2017;53:886-94.
Velasquez CA, Saeyeldin A, Zafar MA, Brownstein AJ, Erben Y. A systematic review on management of nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2018;6:271-8.
Sfyroeras GS, Antoniou GA, Drakou AA, Karathanos C, Giannoukas AD. Visceral venous aneurysms: clinical presentation, natural history and their management: a systematic review. Eur J Vasc Endovasc Surg. 2009;38:498- 505.
Zubair AS, Cheungpasitporn W, Erickson SB, Prieto M. Clinical and safety outcomes of laparoscopic nephrectomy with renal autotransplantation for the loin pain-hematuria syndrome: a 14-year longitudinal cohort study. J Evid Based Med. 2016;9:84-90.
Fabrizio MD, Kavoussi LR, Jackman S, Chan DY, Tseng E, Ratner LE. Laparoscopic nephrectomy for autotransplantation. Urology. 2000;55:145.
Tran G, Ramaswamy K, Chi T, Meng M, Freise C, Stoller ML. Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability. J Urol. 2015;194:738-43.
Duprey A, Chavent B, Meyer-Bisch V, Varin T, Albertini JN, Favre JP, et al. Editor's Choice - Ex vivo Renal Artery Repair with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Long-term Results of Sixty-seven Procedures. Eur J Vasc Endovasc Surg. 2016;51:872-9.