Renal Autotransplantation in the Pig: Surgical Aspects

Abstract

Renal autotransplantation has been carried out in 100 pigs to compare different methods of kidney preservation. In 77 cases a transperitoneal approach was used and the renal vessels anastomosed to the iliac vessels. In 23 cases an anterior abdominal retroperitoneal approach was used and the transplanted kidney placed orthotopi-cally by end-to-end anastomosis between the renal vessels. The transperitoneal technique caused a series of complications most serious being ileus due to adhesions, internal hernias, volvulus, intussusception and wound rupture with postoperative death in six cases. No such complications were observed when the extraperitoneal technique was used. 19% of all animals developed thrombosis in the renal artery of the graft originating from the sutures or from intimal lesions produced by vascular clamps or injections; the latter were not seen when the kidney was placed orthotopically. Implantation of the ureter into the bladder caused stenosis in 13 out of 14 cases, while uretero-ureteral anastomosis caused stenosis and/or urine leakage in four out of 45 pigs. It is concluded that the pig is a suitable animal for the study of transplantation of the kidney. An anterior abdominal retroperitoneal technique with orthotopic localization of the kidney is preferable and uretero-ureteral anastomosis is superior to implantation of the ureter into the bladder.