En-bloc Dual Adult Kidney Transplantation with Multiple Vessels in a Short-Stature Recipient

Chronic kidney disease (CKD) patients opting for deceased donor kidney transplant from a suboptimal functioning kidney donor; to provide adequate working nephrons in the recipient, two adult kidneys are transplanted into one single recipient. Common technique for this surgery used till now is sequential transplantation of one allograft after the other, either one in one iliac fossa or utilising both the iliac fossa’s. We report a technique of e-bloc transplantation of two adult kidneys into a single iliac fossa, with revascularization through the donor (graft) aorta and inferior vena cava. This is a case of a 28‐year‐old male patient with a height of 146 cm, suffering from end stage renal disease, being treated with hemodialysis for the last 12 years. He underwent a dual kidney deceased donor transplant from a 60 year old diabetic donor with terminal creatinine of 1.4. The kidneys were retrieved en-bloc, the graft had two left renal arteries and one right renal artery with 1 renal veins on left and 2 renal vein on right. We did an en bloc transplant with donor IVC and aortic lower ends anastomosed with right common iliac artery and external iliac vein. The kidneys were placed on top of each other. Both ureters were implanted as a common stump as a onlay technique on the urinary bladder over 2 DJ stents. The abdomen was closed with the help of external oblique release incision on the lateral side. The patient had an initial period of ATN for 5 days followed by good urine output and serum creatinine of 0.8 on postoperative day (POD) 12 at the time of discharge. On follow-up, both DJ stents were removed on POD 30. The patient had one episode of urinary tract infection at 2-month postoperative follow-up, which was treated with oral antibiotics. He is followed up till now, i.e., 4 months postoperative with serum creatinine of 0.7 and no proteins in urine. The ultrasound on 3-month follow-up showed both kidneys in the right iliac fossa without any hydronephrosis and good PSV and RI of 0.6. There was no primary nonfunction, no vascular complications in the form of thrombosis, kinking or reduced blood flow and no complication in urinary drainage. No hydronephrosis was noted during the follow-up. The operative time for recipient surgery including the bench preparation was 200 min. At 4 months, serum creatinine levels of 0.8 mg/dl. The procedure described allows implanting two adult kidneys using only one arterial and one venous anastomosis. This technique scores over previously used sequential implantations by reducing cold ischemia time and operative time of recipient surgery. This technique also avoids possibility of dissection of both iliac fossa’s.