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VASCULAR COMPROMISE - FIGURES 51-1 AND 51-2

FIGURE 51-1

Hematomas and areas of poor perfusion. The presence of areas in which there is no flushing with preservation fluid should prompt the surgeon to determine whether to proceed with implantation of the organ. In the illustration above, the lower pole and proximal ureter show an area of hematoma (arrows) with possible parenchymal compromise in the lower pole. This is especially relevant, since the lower pole usually shares its blood supply with the ureter. Transplantation of a kidney with compromised arterial flow to the ureter can frequently result in ureteral ischemia/necrosis and urologic complications in addition to the compromised parenchymal perfusion

FIGURE 51-2

Accidental transection of a branch of the renal artery during back table preparation. These lesions usually occur when dissecting the renal vein and involve branches of the renal artery that cross over the renal vein. Accidental injuries also occur with relative frequency when a branch of the renal artery enters the renal parenchyma outside of the area of the hilum, as in this case. Note that the proximal end of the artery (red arrow) has been tied together with the fatty tissues that surrounded it. The distal end (green arrow) has a short extraparenchymal course. The decision to reconstruct is based on the size of the artery and the territory it supplies. Lower pole arteries of considerable size are usually reconstructed, since they could irrigate the ureter and cause ischemic ureteral strictures and/or urinary leaks. Arteries to the upper pole tend to be more forgiving.

URETERAL COMPROMISE - FIGURES 51-3 AND 51-4

FIGURE 51-3

Stripped and partially transected ureter in a deceased donor kidney. Excessive stripping of the ureter can lead to posttransplant ureteral strictures since the blood supply (arising exclusively from the renal artery in transplanted organs) is frequently compromised. In the nontransplant setting, the ureter is surrounded by a periureteral fascia, carrying a blood supply derived from the renal artery, the gonadal artery, and the superior vesical artery (branch of the internal iliac artery).

FIGURE 51-4

Stripped and partially transected ureter in a deceased donor kidney. Further inspection showed that the ureter had also been accidentally incised and partially transected (arrow) close to the renal parenchyma (Please see Chapter 54 for implantation).

RENAL LESIONS - FIGURES 51-5 AND 51-6

FIGURE 51-5

Renal lesion. Lesion detected in a procured kidney at the time of performing the back table preparation. (B) In this instance, the organ was not transplanted. Pathologic evaluation showed a benign lesion. Please note that some authors advocate (in selected instances) transplanting kidneys with small ...

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