Renal allograft autotransplantation before pelvic irradiation

The anatomical location of a renal allograft places the kidney in jeopardy during radiation therapy of pelvic and perineal malignancies. Alternative choices include avoiding irradiation, altering the dose, or excluding the graft from the field of radiation, with the risk of compromising the efficacy of the treatment. Transplantation of the graft out of the field of irradiation is another option. We describe the management, by allograft autotransplantation, of a renal transplant patient with an invasive carcinoma of the vulva for which postoperative inguinopelvic radiotherapy was advocated. This report underlines the technical difficulties encountered during reoperation on an allograft and the need for versatility in vascular and urologic reconstructions. With these reservations, autotransplantation permits the recovery of a normal renal function and is an option to consider in the salvage of a kidney transplant.