SU1139424A1 - Method of transplantation of donor's kidney with multiple vessels - Google Patents

Abstract

METHOD OF TRANSPLANTING DONOR KIDNEYS WITH MULTIPLE VESSELS by removing them with a block to the aorta region, separating the donor kidneys by longitudinal dissection of the anterior and posterior walls of the aorta, laundering, nonperfusional preservation, implantation of the kidneys, in order to reduce the risk of shrinking the renal system, to reduce the number of renal kidneys, in order to reduce the risk of shrinking the kidneys; kidneys impose the aortic pad on the skeleton of the hollow cylinder, fix it on the skeleton with an elastic ring, wash the donor kidney through all the renal arteries at the same time, cut off the non-viable distal parts of the aortic site from the side of the free end of the cylinder below the elastic ring n after conducting a non-perfused preservation implant a kidney, thus creating arterial anastomoses between the aortic site of the donor kidney and the iliac artery of the recipient in an end-to-side manner. (Ls

Description

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The invention relates to the field of medicine, specifically to transplantation, and is intended for the transplantation of donor kidneys having multiple vessels.

There is a method of donor kidney transplantation, including the implementation of nephrectomy in the donor, alternate cannulation of the renal arteries, washing the kidney with a cold solution under a pressure of 60-80 mm Hg. Art. within 7-10 minutes, followed by the conservation of the organ and the transplantation itself by creating a vascular anastomoses between the renal vessels of the donor and the recipient's imbalance vessels 1.

A disadvantage of the known method is that cannulating all additional small-caliber arteries is technically difficult, with the result that some parts of the kidney remain unwashed and such an organ is not suitable for transplantation.

In addition, alternate cannulation of the accessory arteries lengthens the time of washing the kidney and, therefore, the period of thermal ischemia lengthens by a factor of 2-3 and is 20-30 minutes. But the time of washing the kidney, exceeding 15 minutes, is not permissible, since it reduces the functional usefulness of the transplant in the postoperative period. The result of such difficulties is the rejection of 25-30% of donor kidneys, which greatly limits the clinic's ability to treat CRF patients.

There is a known method of transplanting donor kidneys with multiple vessels by removing them with a block from the site of the port, dividing the donor kidneys by longitudinal dissection of the anterior and posterior walls of the aorta, alternately cannulating the renal arteries, staged washing of the donor kidney, cutting off the renal arteries from the aortic site, nonperfused consistency. implantation, which includes the creation of arterial anastomoses between the renal arteries of the donor and the recipient arteries 2.

The disadvantage of this method is an increase in the time of heat ischemia due to alternate cannulation of the renal arteries and step-by-step washing of the donor kidney.

The aim of the invention is to reduce the time of thermal ischemia.

This goal is achieved in that according to the method of transplanting donor kidneys with multiple vessels by removing them with an aortic block, separating donor kidneys by longitudinal dissection of the anterior and posterior walls of the aorta, laundering, nonperfusional preservation, implantation of the kidneys, after separating the donor kidneys, impose an aorta pad on frame of the hollow cylinder, fix it on the frame with an elastic ring, wash the donor kidney through all the renal arteries at the same time, cut off the non-viable distal aorta The kidney is implanted from the free end of the cylinder below the elastic ring and, after conducting a nonperfusional preservation, arterial anastomoses are created between the aortic site of the donor kidney and the recipient's lateral artery by the end-to-side type.

0 FIG. 1 shows a hollow cylinder, a longitudinal section; in fig. 2 — aortic area with five transverse arteries extending from it and an elastic ring; in fig. 3 - aorta pad superimposed on the cylinder and fixed from above elastic

5 ring, longitudinal section.

The method is carried out as follows.

Nephrectomy at the donor is performed with a block with a site of the aorta 30-40 mm long. The kidneys are divided by dissecting the aorta longitudinally along the front and rear surfaces. The aorta pad 1 with dimensions of 30 x 40 mm with the mouths of the renal arteries 2 is placed on the skeleton of a hollow cylinder 3 with a diameter of 15 mm and fixed on top with elastic

5 ring 4. The upper edge of the cylinder 5 through the nozzle is connected with a perfusion tube. The donor kidney is washed simultaneously through all the renal arteries with a COLD solution at 3-4 ° C under a pressure of 60-80 mm Hg. Art. Time laundering

0 takes 8-10 min. At the end of the laundering, the aorta is cut off at the bottom edge of the 6th cylinder, indent 1.5-2.0 mm from the elastic ring.

Thus, the remaining 20–40 mm portion of the aortic pad with the mouth of the renal arteries remains intact and is fully suitable for creating a vascular anastomosis. Subsequently, the kidney is preserved by the non-perfusion method, and a direct transplant is performed, including the creation of a vascular anastomosis, with an arterial anastomosis being created between the recipient's ileal artery and the donor's aortic site. Example. Donor B. 36 years. Enrolled in the intensive care unit 30 minutes after

5 drops from height (about 10 m). Diagnosis: fracture of the base of the skull, brain injuries, subdural hematoma. All relevant resuscitation measures have been taken. Blood pressure fluctuated within PO-100 for 50-

70 mm Hg Art. Diuresis has been saved. Death came after 10h. Five minutes after the death was established, the vagal cavity and zabryuchinny space were opened by a cruciate incision, the ureter, the patellar aorta and the lower floor of the vein were separated. The vascular pedicle of the left kidney is represented by four arteries - one main and three ds1bavochnye - and one vein. Applied the proposed method of kidney transplantation.

The nephrectomy is produced by a block with a 4-cm long aortic area. The aorta is longitudinally cut along the anterior and posterior surface, the kidneys are separated. The aorta area with the renal artery orifices is superimposed on the skeleton of the hollow cylinder, fixed on top with an elastic ring. Through the perfusion tube, the kidney is washed with cold Collins solution. The time of laundering was 9 minutes, the total time of heat search was 17 minutes. The kidney has acquired a light color, dense texture. Macroscopically recognized as suitable for transplantation. At the end of washing, the aorta is cut off along the lower edge of the cylinder, 1.5 mm indent from the elastic ring. After 10-hour conservation-free perfusion, kidney allotransplantation was performed. Arterial anastomosis is imposed between the aortic area.

end-to-side and external iliac artery. After inclusion of the kidney into the bloodstream, urine appeared after 8 minutes. The value of creatinine in the blood on the 8th day after surgery decreased from 12.6 to 3.0 mg%. Therefore, using the proposed method, it was possible to keep the donor kidney suitable for transplantation.

The method of donor kidney transplantation with multiple vessels is used in the presence of a variant vascular pedicle, which has more than two renal arteries, which increases the number of donor kidneys suitable for transplantation by 25-30%, shortens the period of thermal ischemia by 2-3 times, improves the functional the usefulness of the kidney transplant in the postoperative period.

ABOUT

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Claims (1)

(54 METHOD OF TRANSFER OF DONOR KIDNEYS WITH MULTIPLE VESSELS by removing them with a block of the aorta, separating donor kidneys by longitudinal dissection of the anterior and posterior walls of the aorta, washing, non-perfusion preservation, implantation of the kidneys, characterized in that, with the aim of reducing the time and donor kidneys place the aortic area on the skeleton of the hollow cylinder, fix it on the skeleton with an elastic ring, wash the donor kidney through all renal arteries at the same time, cut off non-viable distal The alal portions of the aortic area from the side of the free end of the cylinder below the elastic ring and after nonperfusion preservation, implant a kidney, while creating arterial anastomoses between the aortic area of the donor kidney and the iliac § recipient artery of the end-to-side type.