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[Vascular prosthesis in kidney transplantation]
L M Alvarez Castelo1, C García Freire, J Rodríguez-Rivera García
1Servicio de Urología, Hospital Juan Canalejo, La Coruña, España.
Insights
Kidney transplant patients may need vascular prostheses for aortoiliac vessel repair. Preoperative cardiovascular assessment is crucial for successful outcomes in these complex cases.
Area of Science:
- Nephrology
- Vascular Surgery
- Transplant Surgery
Background:
- Kidney transplantation is a common treatment for end-stage renal disease.
- Aortoiliac vascular disease can complicate kidney transplantation.
- Vascular prostheses may be necessary for managing these complications.
Observation:
- Three cases of kidney transplantation requiring vascular prosthesis repair are presented.
- These repairs involved aortoiliac vessels, with one patient having a pre-transplant aorto-bifemoral prosthesis.
- Two patients required prosthesis for iliac artery lesions identified during transplantation.
Findings:
- Initial surgical results were satisfactory with no prosthesis-related complications.
- Two patients achieved functioning renal grafts post-transplantation.
- One patient experienced graft failure due to acute tubular necrosis and rejection, leading to mortality.
Implications:
- Thorough preoperative cardiovascular evaluation is essential for kidney transplant candidates.
- Familiarity with vascular prosthesis materials and techniques is important for surgeons.
- The optimal timing (simultaneous vs. staged) of aortoiliac repair and kidney transplantation in severe cases remains debated.
Objective:
Three cases of kidney transplantation that required a vascular prosthesis are described and the literature reviewed.
Methods:
Of 920 cases of kidney transplantation, 3 required a vascular prosthesis to repair the aortoiliac vessels. One patient with severe atherosclerotic disease had an aorto-bifemoral prosthesis (Gore-Tex) six months before renal transplantation and the other two patients required a vascular prosthesis to repair iliac artery lesions discovered during transplantation.
Results:
The initial surgical results were satisfactory. No complications arising from the vascular prosthesis were observed. Two patients have a functioning renal graft, but the third patient developed acute tubular necrosis and tubulo-interstitial rejection and died from acute pulmonary edema.
Conclusion:
The importance of the preoperative cardiovascular evaluation in patients undergoing kidney transplantation is underscored. Some patients may require a vascular prosthesis. We should therefore be familiar with the prosthetic materials and the surgical techniques, which are not particularly difficult, and optimum results can be achieved. In patients with both end-stage renal disease and severe aortoiliac atherosclerotic disease, the controversy remains whether aortoiliac repair and kidney transplantation should be done simultaneously or in two stages.