Renal autotransplantation: an alternative to standard renal revascularization procedures

From January 1978 through December 1987, 22 patients underwent 23 renal autotransplantation procedures for the treatment of renovascular hypertension through the retroperitoneal approach. The causes of the renal artery stenosis were as follows: atherosclerosis (15), fibromuscular dysplasia (6), and Takayasu's arteritis (1). Indications for renal autotransplantation were as follow: disease extending into the renal artery branches (10), stenosis of multiple renal arteries (6), atherosclerotic aorta in high-risk patients (4), and stenosis of renal artery in children (2). The mean preoperative blood pressure of 205 +/- 6/109 +/- 3 mm Hg decreased significantly to 139 +/- 4/77 +/- 2 mm Hg (p less than 0.001). The serum creatinine decreased significantly from a mean preoperative level of 2.2 +/- 0.8 mg/dl to a mean postoperative level of 1.4 +/- 0.4 mg/dl (p less than 0.05). Eleven patients with preoperative renal dysfunction had a significant decrease in the serum creatinine from a mean preoperative level of 3.4 +/- 0.3 mg/dl to a mean postoperative level of 1.9 +/- 0.2 mg/dl (p less than 0.001). One operative death occurred as a result of myocardial infarction. There were three postoperative complications, none of which affected the ultimate result in blood pressure or renal function. This experience demonstrates that in selected patients, renal autotransplantation is an excellent alternative in the surgical treatment of renovascular hypertension.