Kidney Autotransplants - A Preferred Treatment for Renal Disorders

Introduction:

There are many treatments available when it comes to kidney disorders. Such procedures range from medications to minimally invasive procedures and surgeries. While most of them are quite effective, certain situations require renal autotransplantation. It is a relatively safe procedure that can treat several vascular (related to blood vessels), urologic (related to the urinary system), and other diseases with an acceptable outcome.

The procedure was first reported in 1963; they surgically repaired an injury to the ureters following surgery of the aorta by reimplanting the organ in the pelvic area. Kidney autotransplant, also known as renal autotransplantation or renal reimplantation, is a type of kidney-saving surgery that helps individuals manage severe, long-lasting pain. In this procedure, the surgeon removes the kidney that is causing pain and transplants it into a different body part.

Even though one of the kidneys has been transplanted to a different location, the body still works normally since it has two completely healthy kidneys. Kidney autotransplant surgery is an option that gives hope when all the other treatment procedures have been utilized. Kidney autotransplant is a rare, safe, and effective procedure for treating various complex renal conditions. In some instances, it might prove to be a kidney savior for a particular group of patients.

Why Is Kidney Autotransplant Surgery Preferred?

During organ preservation surgeries, there was prolonged reversible ischemic (less blood flow to the organ). Since then, kidney autotransplantation surgeries have become an alternative method by kidney transplant surgeons for treating different urological conditions. Preserving perfusions and cold storage of the kidneys make time-consuming and cumbersome repair work on kidney tissue, blood vessels, ureter, and pelvis possible without endangering the kidney function. Thus, ex-vivo surgery (carried out outside the body) might save many patients who would otherwise undergo kidney removal. In addition, in many cases, cold storage of the kidney might allow autotransplantation to be postponed to the next day to stabilize the blood circulation in an unstable patient.

How Does Kidney Autotransplant Differ From Kidney Transplant?

Kidney autotransplant and kidney transplant are two completely different things. In a kidney transplant, a kidney from a deceased or living donor is placed within the recipient, and the immunity is suppressed, so the body does not reject the transplanted kidney. While in kidney autotransplant, the individual's kidney is removed and transplanted into some other body part. No immunosuppression medication is needed as their own kidney is placed in the body.

Apart from reducing the risk of nephrectomy, kidney autotransplant can be used as an alternative to complex kidney pathologies that require surgical interventions like renal artery bypass or reconstruction, which leads to a lot of kidney damage due to prolonged restriction of blood flow or ischemia. It is a very practical approach for resuming kidney function. The main criteria for using kidney autotransplantation are to preserve the kidney tissues. It is generally the last option before nephrectomy or removal of kidneys. It is highly effective in surgically treating kidney pathologies. Kidney function is one of the criteria to predict the risk of kidney failure in renal autotransplant cases. Therefore the benefit of kidney autotransplantation is that chronic kidney disease (CKD) can be investigated in depth.

Who Are All Eligible for Renal Autotransplant?

Renal autotransplant is an effective procedure for patients when other conventional treatment options have been used but in vain. The most common indication is ureteral lesions. It allows a direct connection between the pelvic and the visceral organs. Kidney or ureteral cancers/tumors treated with kidney autotransplant have been found to have a low recurrence rate and few complications. It is a rare procedure and is effective.

• Nutcracker Syndrome - Disorder due to a compressed blood vessel.

• Loin Pain Hematuria Syndrome - Kidney pain and blood in the urine.

• Vascular malformations.

• Kidney stones.

• Kidney cancer.

• Short and injured ureters.

• Pelvic trauma.

• Pelvic venous congestion.

• Renal artery pathology.

• Aortic Aneurysm - Bulge in the large artery carrying blood from the heart to different body parts.

• Chronic Hematuria - Blood in the urine.

• Retroperitoneal Fibrosis - Inflammation at the back of the abdomen.

• Idiopathic Chyluria -Milky white urine.

Extracorporeal renal vascular reconstruction and autotransplantation have improved results in kids with renovascular hypertension and can be performed in kids less than a year.

How Is Kidney Autotransplant Surgery Carried Out?

The surgery is performed in two ways. One involves making a large incision in the center of the abdomen to remove the kidney and relocating it to a different body part. The other one consists of the use of minimally invasive surgery with the help of a small incision and the use of camera-laparoscopic surgery.

During the procedure, surgeons perform laparoscopic surgery to make small cuts to view the abdominal wall. A small rubber tube is placed into the neck of the bladder to track urine output. The rubber tube is placed for three to seven days within the bladder. Laparoscopic surgery uses small incisions with the help of a camera.

An instrument is inserted in the abdominal wall via a small incision to examine the organs and perform surgery. Specialized instruments and a camera are used to remove the kidney. After the kidney removal, the blood from the kidney is flushed and cooled with the help of a solution so that the kidneys remain preserved. Then the kidney is placed in a new position in the pelvis next to the urinary bladder.

A new connection from the ureter to the urinary bladder is made, and a small tube or stent is placed in the ureter to keep the ureter open during the recovery phase. This stent stays for four weeks after surgery completion. This movement of the kidney to another place cuts the kidney's connection with the nerves. This breakage causes the pain to stop. The surgery takes around four to eight hours, but time can vary. There is minimal blood loss and pain, and he quickly recovers. The stay in the hospital is for three to seven days.

Conclusion:

Kidney autotransplant is a sound and safe procedure with satisfactory results. This procedure is commonly performed in case of diseases of the kidney blood vessel and ureter pathologies. The mortality rate involving kidney autotransplant is low, but the morbidity is relatively high. Individuals who had kidney autotransplant for ureter pathologies and those who underwent the procedure due to complications of other procedures have the lowest and highest rate of morbidity, respectively.

Obesity, preoperative electrolyte disorders, and preoperative kidney failure are some factors predicting patients' morbidity. Controlling the electrolyte imbalances, perioperative care, and minimally invasive approaches to kidney autotransplant might decrease the possible postoperative morbidity in individuals.

During follow-ups, renal auto transportation has been found to show less complication rate, preserved renal function, and no recurrence of cancer. Transplantation failure has been found to occur in a very small percentage of patients. Obesity is associated with morbidity in individuals with kidney autotransplant.

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