Renal autotransplant
Renal autotransplant is a kidney-saving surgery that can be used in select patients. During the procedure, the patient’s kidney and ureter are removed. The kidney is then implanted—or placed—in a different part of the body, typically in the pelvis adjacent to the bladder. If successful, the patient benefits from having two functioning kidneys, even though one has been moved to a different location in the body.
The UCHealth Transplant Center in metro Denver is the only transplant program in the Rocky Mountain region that performs renal autotransplants and that offers minimally invasive robotic surgery to appropriate patients.
Patients eligible for renal autotransplant
Renal autotransplant surgery is generally not an option for all patients. The indications for this surgery generally fall into the categories of nutcracker syndrome, loin pain hematuria syndrome, trauma, cancer and vascular malformations.
Due to these complex conditions, your UCHealth team is multidisciplinary and has expertise in several different areas, including urology, interventional radiology, transplant surgery, psychiatry (behavioral health), addiction medicine, nursing and social work.
This cross-functional team can assess each patient’s situation to determine if renal autotransplant is the right procedure for them.
Renal autotransplant: benefits and risks
Benefits
Renal autotransplant surgery has many benefits, but the primary benefit is preserving kidney function while treating the underlying condition.
For example, we have a greater than 90% success rate at relieving chronic kidney pain for certain conditions with renal autotransplant.
In addition to these quality of life benefits, the patient is left with two functioning kidneys. In other cases, renal autotransplant has been used as a kidney-saving procedure for trauma, cancer, or other special circumstances.
Risks
Every surgery carries potential risks. Because renal autotransplant is a complex procedure, there are chances for complications or even death to occur for patients despite receiving the very best care.
Other risks include, but are not limited to:
- A reaction to the anesthesia received during surgery.
- Blood clots in the legs or lungs.
- Bowel problems such as slow or blocked bowels.
- Delayed wound healing.
- Hernia.
- Injury to other organs such as the pancreas, stomach or intestine.
- Loss of the kidney.
- Mild or severe infections (pneumonia, urinary tract or wound).
- Mild, permanent weakness, numbness and scarring at the incision site.
- Pain in the incision that does not resolve.
- Repeat surgeries.
- Stroke or heart attack.
- Uncontrolled bleeding that requires a blood transfusion.
Renal autotransplant surgery
The surgery typically lasts between four to eight hours, but times can vary.
To start, a small rubber tube is placed into the bladder to help track urine output, and this remains in place for three to seven days.
Two surgical approaches are possible
The surgeon uses one of two approaches to perform the surgery:
- One approach involves making a large incision in the middle of the abdomen to remove the kidney, and then moving it to a different part of the body.
- The other involves a minimally-invasive approach, using either a small camera and small working ports or a surgical robot. The minimally invasive approach is generally the preferred method, due to less blood loss, less pain and a quicker recovery.
After the kidney has been removed, it is flushed with anticoagulation and preservation solutions in ice. The new location for the kidney is prepared, and then the kidney is placed in this new location by reconnecting the blood vessels of the kidney.
Lastly, a new connection from the ureter to the bladder is made and a very fine tube (stent) is placed in the ureter to make sure the ureter stays open during the recovery period. This stent will stay in place for about four weeks after surgery.
The typical hospital stay for a renal autotransplant ranges from three to seven days.
Medical conditions that can be treated by a renal autotransplant
Nutcracker syndrome
Nutcracker syndrome (NCS) is a disorder where the left renal vein gets compressed between the superior mesenteric artery (SMA) and abdominal aorta. Nutcracker syndrome gets its name because this compression is like a nutcracker crushing a nut. The more the renal vein gets compressed, the more pressure builds up, eventually causing the blood to find new routes out of the kidney. This syndrome is typically accompanied with constant flank pain, groin pain, pelvic fullness and blood appearing in the patient’s urine.
Loin pain hematuria syndrome
Loin pain hematuria syndrome (LPHS) causes patients to experience severe, unexplained pain in one or both of their flanks (upper abdomen or back and sides) and blood in their urine (hematuria). The pain can vary frequency and length and appear on one or both sides of the body. LPHS is not known to cause major kidney damage, end-stage kidney disease or early death.
Because its symptoms mimic so many other conditions, doctors often find LPHS very difficult to diagnose. For this reason, your doctor will typically need to rule out other potential urologic and kidney conditions before diagnosing LPHS.
Renal vascular anomalies
Renal vascular anomalies include a wide variety of vascular issues including renal arteriovenous malformations (AVMs), renal artery aneurysm, renal vein thrombosis and renal artery stenosis. Auto-transplant is an exceedingly rare procedure we have used to treat these conditions as a last resort to save kidney function.
Cancers
For most kidney cancers, surgery is the best option. In rare, special situations, we have used renal auto-transplantation to remove the cancer while preserving the kidney and its renal function.
Trauma
Renal or ureteral trauma occurs when a kidney is injured either by a blunt trauma, penetrating trauma or in some cases surgery. While renal autotransplantation is generally not performed for these situations, we have performed this surgery when the need to preserve kidney function is necessary and other, more typical, treatment options have failed.
References
National Center for Biotechnology Information (NCBI): National Library of Medicine. Renal Autotransplant Results in Pain Resolution Following Left Renal Vein Transposition (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502017/)
Pubmed: National Library of Medicine. Indications for renal autotransplant: an overview (https://pubmed.ncbi.nlm.nih.gov/25871361/)