Transplantation as Treatment of End-Stage Renal Disease
ADJUSTED MORTALITY RISK RATIOSFOR END-STAGERENAL DISEASE BY TREATMENT MODALITY
All patients on dialysisPatients on dialysis who are on a waiting listCadaveric kidney transplantation recipientsLiving-donor related kidney transplantation recipients
USRenal Data System .
TECHNICAL CONSIDERATIONSFOR RECIPIENTSOF KIDNEY TRANSPLANTATION
Right or leftGross appearance and sizeArterial anatomyVenous anatomyUreteral anatomy
Abdominal wall anatomySizeArterial anatomyVenous anatomyUrinary tract anatomy and functionGender
The adjusted mortality risk ratio for patients on dialysis placed onthe renal transplantation waiting list is greater than that for kidneytransplantation recipients, suggesting transplantation itself resultsin a reduced mortality risk for patients with end-stage renal diseasewho are treated .
A number of factors concerning the kidney graft and recipientdetermine the technique of renal transplantation in each recipient.Placement of the kidney graft in the contralateral iliac fossa ispreferable because the renal pelvis becomes the most medial of thevital renal structures and thus readily available for future recon-struction if ureteral stenosis occurs. Areas of previous abdominalsurgery such as ileostomy, colostomy, renal transplantation, or aperitoneal dialysis exit site are avoided, if possible. A kidney toolarge for the recipient’s iliac fossa is usually placed in the rightretroperitoneal space and revascularized with the aorta or commoniliac artery and interior vena cava or common iliac vein. Pelvic vas-cular disease and previous renal transplantation determine whetherthe aorta or internal iliac, external iliac, common iliac, native renalor splenic artery will be selected for renal artery anastomosis. Theuse of both internal iliac arteries in serial renal transplantations inmen is avoided to prevent impotence . The method of urinarytract reconstruction depends primarily on the status of the recipi-ent’s bladder, continent reservoir, or incontinent intestinal conduit.
Cadaveric Kidney Graft
Instrument setup for cadaveric kidney graft preparation. The towelprevents renal movement during dissection.