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Chapter-36 Implantation—En Bloc Kidneys

BOOK TITLE: Kidney & Pancreas Transplantation

Author
1. Molmenti Ernesto P
2. Basu Amit
3. Philosophe Benjamin
4. Eubanks Alicia
ISBN
9789351523390
DOI
10.5005/jp/books/12547_37
Edition
1/e
Publishing Year
2015
Pages
2
Author Affiliations
1. Hofstra Northwell School of Medicine, Long Island, New York, USA, North Shore-LIJ Health System, Long Island, New York, USA; Hofstra North Shore–LIJ School of Medicine, Long Island, New York, USA
2. North Shore-LIJ Health System, Hempstead, New York, USA
3. Johns Hopkins Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
4. University of Southern Florida, Tampa, Florida, USA
Chapter keywords
kidney implantation, en bloc kidneys, donors, inferior vena cava, IVC, duplex-Doppler ultrasound evaluation, intravenous heparin

Abstract

This chapter discusses about the procurement and back table preparation, implantation, and follow-ups of en bloc kidneys. Kidneys from donors less than 2 years or under 15 kg are split, but good results are seen with split kidneys at a much younger age or lesser weight. In the back table preparation, the proximal inferior vena cava, IVC and aortic openings are sutured close taking care not to compromise orifices of renal arteries or veins. Small collaterals as well as lumbar vessels are identified and tied in order to prevent post-implantation bleeding. Implantation involves starting low dose intravenous heparin to decrease the risk of thrombosis, wrapping the en bloc kidneys in a sponge with ice and brought onto the operative field. A delicate clamp is placed on the donor IVC distal to the kidneys and the clamp on the recipient iliac vein released. Routinely obtain a duplex-Doppler ultrasound evaluation in the immediate postoperative period.

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