Vascular Complications After Renal Transplantation
Kitapta bölümler > Diğer · 2012
Yazarlar: Taylan Ozgur, Cuneyt Hoscosku
Vascular Surgery, Diğer, SAGE Publishing, B, Uluslararası, 2012, ,
DOI: 10.5772/25523
Özet
IntroductionRenal transplantation has become the treatment of choice for end-stage renal disease due to advances in surgical techniques, perioperative management, and immunosuppressive regimens.Surgical techniques for kidney transplantation were first described in 1951 by Kuss et al. and have since changed very little.The most common surgical procedure is extraperitoneal transplantation in the right iliac fossa, with end-to-side to the external iliac artery or end-to-end anastomosis to the internal iliac artery, and end-to-side anastomosis to the external iliac vein.The overall incidence of vascular complications following kidney transplantation is low, especially when compared to other solid organ transplantation of such organs as the liver or pancreas.The incidence of vascular complications following renal transplantation ranges from 3% to 15%. 1 Arterial complications occur more frequently and are more dangerous than venous.Both arterial and venous thromboses tend to occur within the first few days of transplantation.Improvements in immunosuppressive therapy have led to a 1-year post transplantation acute rejection incidence rate of <20%.The incidence of graft loss due to acute and chronic rejection is decreasing; however, the incidence of early allograft loss due to acute vascular complications has remained constant, accounting for a proportionally higher percentage of early loss.Reducing the incidence of vascular complications depends to a great extent on the careful evaluation of the recipient, the donor kidney, and the surgical technique used for implantation. Transplantation regionAs a general rule, left kidney is implanted in the right iliac fossa, whereas right kidney is implanted in the left iliac fossa.Using this technique the urinary collecting system is medially located, facilitating easy access to the ureter and possible percutaneous kidney biopsy; however, because left donor nephrectomy is commonly performed and the right iliac veins are more superficial, kidneys are implanted in the right retroperitoneal iliac fossa.The left iliac fossa is reserved primarily for pancreas transplantation candidates, patients with previous transplants, and those with vascular problems.In patients undergoing www.intechopen.comVascular Surgery 86 simultaneous pancreas and renal transplantation, or in those with a history of surgery in both iliac regions intraperitoneal transplantation should be performed.