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Living donor kidney transplant following nephrectomy for renal artery stenosis with arterial reconstruction and viability assessment using ex vivo normothermic perfusion
  1. Robert Pearson,
  2. Jonathan Wubetu,
  3. Andrew Jackson and
  4. David Kingsmore
  1. Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to Mr Robert Pearson; robert.pearson5{at}nhs.scot

Abstract

Ex vivo normothermic perfusion (EVNP) is increasingly recognised as a viability tool to increase organ utilisation in deceased donor transplantation. We report the use of EVNP to assess graft perfusion quality following indication nephrectomy and back-bench arterial reconstruction in a case of renal artery stenosis, unamenable to endovascular treatment. Once explanted, it was not possible to effectively cold perfuse the graft through the main renal artery or collaterals. An arterial reconstruction was performed with patch angioplasty using the largest collateral creating a single common stem. EVNP was used to assess organ perfusion and, therefore, viability. Excellent global perfusion was evident alongside urine production, demonstrating that the arterial reconstruction was satisfactory. A patient with end-stage renal disease was consented with particular attention to the uncertainty of the underlying donor disease process and long-term outcome of the reconstruction. Primary function was achieved and recipient estimated glomerular filtration rate (eGFR) remains stable at 58 mL/min/1.73 m² at 6 months.

  • renal transplantation
  • transplantation

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Footnotes

  • Twitter @robpearson88

  • Contributors RP—arterial reconstruction, delivery of EVNP technology, manuscript preparation. JW—manuscript preparation. AJ—delivery of EVNP, manuscript review. DK—patient consent, arterial reconstruction, manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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