Ex-vivo renal surgery feasible for complex renal conditions
It appears that ex-vivo renal surgery may be performed for complex renal pathologies, but it is necessary to carefully select patients to achieve positive outcomes, a recent study suggests.
The investigators examined three patients who underwent ex-vivo renal surgery and autotransplantation for benign and malignant renal conditions. The procedures were performed in the urology and transplant departments between July 2015 and January 2016.
Patient 1 was a 63-year-old man presenting with spontaneous bleed from a renal mass in a solitary functional right kidney. Patient 2 was a 50-year-old man with bilateral renal tumours involving renal veins. Finally, patient 3 was a 50-year-old man with two previous failed right-sided pyeloplasties.
Of the three patients included in the study, none had intraoperative complications. Patient 1 had laparoscopic nephrectomy, ex-vivo partial nephrectomy followed by autotransplantation. No disease recurrence happened after a 6-month follow-up, and renal functions were stable.
Bilateral open radical nephrectomies were carried out in patient 2. Autotransplantation was performed on the right kidney following ex-vivo partial nephrectomy. On the left, a further procedure was cancelled after radical nephrectomy because of extensive disease involvement. The patient became anuric with poor Doppler signals after the procedure.
Following exploration, surgeons suggested complete renal vein obstruction with infarction of the autotransplanted right kidney requiring nephrectomy. There was disease recurrence found at the native renal bed at 6 months’ follow-up.
Finally, patient 3 underwent laparoscopic nephrectomy, ex-vivo pyeloplasty and autotransplantation. The patient was asymptomatic with stable renal functions at 12 months’ follow-up.