CHAPTER 50: Kidney Backtable Preparation

INTRODUCTION

• Correct identification of donor organ and intended recipient following established protocols is essential to prevent potentially fatal errors

• Sterility is maintained at all times

• All specimens preferably should be sent for pathologic identification and evaluation

KIDNEYS PROCURED FROM LIVE DONORS

• The kidney is placed inside a bag containing cold preservation fluid within a basin with sterile ice

• Clips/staples (if present) are removed from the artery and vein

• Preservation fluid is perfused through the artery until the venous effluent is clear (usually 60–120 mL)

• Parenchyma, ureter, and vessels are inspected for injuries and/or abnormalities

• The artery and vein are prepared for implantation:

  • The distal ends are freed of surrounding tissues

  • Venous branches (e.g., gonadal, suprarenal, lumbar, small branches to surrounding fatty tissues) are tied if not previously addressed during the procurement

  • In instances of multiple arteries, they can be reconstructed so that a single ostium is implanted onto the recipient or otherwise kept as is to be implanted individually onto the recipient artery

  • We routinely implant right renal veins into the recipient without performing any type of reconstruction

• Perirenal fat is removed as necessary

• Dissection of the hilum should be kept to a minimum to avoid backtable injuries

• The ureter should be kept with as much fascia and tissues surrounding it as possible in order to prevent unnecessary devascularization

• The gonadal vessels preferably should be tied distally (or completely removed) to prevent bleeding after implantation

KIDNEYS RECEIVED IN PUMPS OR SHIPPING CONTAINERS

• The kidney is placed inside a bag containing cold preservation fluid within a basin with sterile ice

• The parenchyma, ureter, and vessels are inspected for injuries and/or abnormalities

• The artery and vein are prepared for implantation:

  • The distal ends are freed of surrounding tissues

  • Venous branches (e.g., gonadal, suprarenal, lumbar, small branches to surrounding fatty tissues) are tied if not previously addressed during the procurement

  • We do not routinely reconstruct right renal veins

    • We encountered no major problems implanting grafts with short veins, especially if the recipient external iliac vessels are transposed (the external iliac vein is placed lateral and dorsal with respect to the external iliac artery)

    • Alternatively, it is possible to reconstruct them to achieve a greater length. Usually donor inferior vena cava is used for the reconstruction

  • In instances of multiple renal veins, it is generally safe to preserve only the dominant one for implantation

  • In instances of multiple arteries, they can be reconstructed so that a single ostium is implanted onto the recipient or otherwise kept as is to be implanted individually onto the recipient artery

    • In cases in which an aortic patch contains several arteries that are wide apart, the patch in between the ostia can be resected and the edges brought together into a smaller patch

DECEASED DONOR KIDNEY (FIGURES 50-1 – 50-3)