Kidney

Procedures and surgical techniques employed in kidney transplantation (Tso & 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 & Nicol, 2010).

Living kidney donation

For living kidney donors, single renal vascular anatomy is preferred; the kidney with the simplest vascular anatomy (ideally one artery and one vein) is usually 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. Figure 10 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 10: 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 renal transplant recipients. No significant differences were found in recipient survival or graft survival (median follow-up of 50 months) (Lafranca et al., 2016).

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 after kidney transplantation. A summary of the guidelines is available (KDIGO Transplant Work Group, 2009; Kasiske et al., 2010). The British Transplantation Society and The Renal Association have specific guidelines for the failing kidney (Andrews: Standards Committee of BTS, 2014; British Transplantation Society, 2014), as well as recently updated guidelines for living donor kidney transplantation (British Transplantation Society, 2018).