Kidney Autotransplantation for Renal Artery Aneurysm: Case Series and a Systematic Review
Renal artery aneurysm (RAA) is a rare vascular disease. Kidney autotransplantation (KAT) is the treatment option when endovascular approach is not available. However, the evidence on KAT for RAA is mostly limited to small case series or reports. Here, we describe our 2 center experience of KAT for RAA, and provide the results of our systematic literature review to evaluate the outcomes.
METHODS:A retrospective 2 center study was conducted in patients undergoing KAT for RAA between 2010 and 2018. Moreover, a systematic review was performed on medical databases to evaluate the outcomes of KAT for RAA.
RESULTS:Nine patients were surgically treated at our institutions: eight with laparoscopic nephrectomy (LN), and 1 with open followed heterotopic KAT. All RAAs were ex-vivo reconstructed, and in 3 cases a vein graft was used for reconstruction. There were 2 postoperative major complications including 1 graft loss. In the systematic review, 102 studies with 355 patients were included. In 35 patients (9.9%) a minimal invasive approach was performed. The incidence of postoperative major complications and graft loss was 9.4% and 4.1%.
CONCLUSIONS:Our experiences showed that laparoscopic approach for nephrectomy followed heterotopic KAT was feasible with good postoperative outcomes. KAT is an effective treatment for RAA when endovascular approach is not feasible for interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.
CET Conclusion
| Reviewer: | Mr John O'Callaghan, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | This paper is based around a case series of renal auto-transplantation for a rare indication- renal artery aneurysm. In addition, the paper includes a systematic review. The review searched multiple databases, and abstracts were screened in duplicate although it does not appear that data was extracted in duplicate. There is a formal quality assessment of the 102 papers included (66% of which were single case reports). The authors summarise the demographics of included patients and the surgical approaches used. Overall patient and graft outcomes seem acceptable, but a minority of papers reported outcomes beyond 1 year. It would have been useful to see a comparison with endovascular techniques, where this approach could have been technically feasible. |
Study Details
| Aims: | This paper reports a case series of kidney autotransplantation (KAT) for renal artery aneurysm (RAA). It also includes a systematic review evaluating outcomes of KAT for RAA. |
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| Interventions: | In the systematic review, electronic databases including Medline Ovid, Embase, Cochrane CENTRAL , Web of science and Google scholar were searched. Studies were screened for eligibility by two independent reviewers. The methodological quality of the included studies were also assessed. |
| Participants: | 102 studies were inclded in the systematic review. |
| Outcomes: | The main outcomes of interest included postoperative complications, graft loss, and postoperative hospital stay. |
| Follow Up: | N/A |
Metadata
| Funding: | No funding was received for this study |
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| Publication type: | Multicenter Study, Systematic Review |
| Review registration: | UMIN000039450 |
| Organ: | Kidney |
| Language: | English |
| Author email: | kotakagi15@gmail.com |
| MeSH terms: | Aged; Female; Humans; Male; Middle Aged; Aneurysm; Graft Survival; Italy; Kidney Transplantation; Laparoscopy; Nephrectomy; Netherlands; Postoperative Complications; Renal Artery; Retrospective Studies; Transplantation, Autologous; Treatment Outcome |