RENAL AUTOTRANSPLANTATION AND EXTRA-CORPOREAL SURGERY

Abstract

Renal autotransplantation with/without extra-corporeal surgery was performed in 53 patients between September, 1975 and december, 1987. Original disease was obstructive disease of the upper urinary tract in 25 patients, renovascular hypertension and renal vascular disease in 13, renal calculous disease in 12 and renal cell carcinoma in 3. Ten of the 53 patients had solitary kidneys.
Three patients died on 14, 21 and 49 postoperative days of massive bleeding with disseminated intravascular coaglopathy caused by the rupture of transplant arterial anastomosis (1 patient with urinary obstructive disease) and sepsis caused by wound infection (2 patients with renal calculous disease). Two kidneys were removed on operative day and 8 postoperative days due to arterial thrombosis in 2 patients with aneurysma of intrarenal artery. The deterioration of renal function was observed in previously damaged kidneys of two patients with extensively damaged ureter. No other severe complications were observed.
In 23 of 24 patients with the obstructive disease of the upper urinary tract, disappearance or improvement of the obstructive change was observed after surgery. All 5 patients with renovascular hypertension showed normo-tension without administration of antihypertensive drugs after surgery. In 3 of 5 patients with an aneurysma of the intrarenal artery, the aneurysma was removed and rconstraction of the artery was performed successfully. Two patients with arterio-venous fistula and one patient with nut creacker syndrome had no severe hematuria with bladder tamponade after surgery. Ten of 12 patients with renal calculous disease were treated successfully without residual calculs by this procedure. Three patients who had solitary kidney with renal cell carcinoma were treated successfully by this procedure. These patients have no local recurrence 8 to 30 months after surgery. These results indicated that, this procedure is applicable to relieve the kidney with extensively damaged urinary drainage system, renal and/or intrarenal vascular disease and renal cell carcinoma. Most patients with calculous disease and renovascular hypertension should be primarily treated with extracorporeal shock wave lithotripsy and endoscopic surgery, and with transluminal angioplasty.