Kidney

Procedures and surgical techniques employed in kidney transplantation (Tso and Pearson, 2014) and basic surgical anatomy in kidney transplantation (Khaja et al., 2014) have recently been reviewed.

Caring for Australasians with Renal Impairment (CARI) guidelines for surgical techniques in living donor nephrectomy report that recipient outcomes are equivalent with open live donor and laparoscopic nephrectomy (Gibbons and Nicol, 2010).

Living kidney donation

For living kidney donors, single renal vascular anatomy is preferred, with the kidney with the simplest vascular anatomy (ideally one artery and one vein) generally being selected. Complex renal vascular anatomy is not uncommon with 25% of donors in a series of 951 living kidney donors showing vascular multiplicity in one or both kidneys. The figure below shows the relative proportion of kidney donors with vascular multiplicity (Lafranca et al., 2016).

Variation in renal vascular anatomy determined during live donor nephrectomy (n=951) (Lafranca et al., 2016).

Figure 1: Variation in renal vascular anatomy determined during live donor nephrectomy (n=951) (Lafranca et al., 2016).

Review of the series concluded that renal vascular multiplicity in a living kidney donor had little impact on the clinical outcomes of the donor and also renal transplant recipients: no significant differences were found in recipient survival or graft survival (median follow-up of 50 months) (Lafranca et al., 2016).

UK guidelines for living donor kidney transplantation have now also been published (Andrews et al., 2012; British Transplantation Society and Renal Association, 2011).

Clinical practice guidelines for the monitoring, management, and treatment of kidney transplant recipients have been published by the Kidney Disease: Improving Global Outcomes (KDIGO) group. The guidelines deal with the prevention and treatment of complications that arise following kidney transplantation, a summary of the guidelines is available (KDIGO Transplant Work Group, 2009; Kasiske et al., 2010).