Short and Midterm Results of Internal Jugular Vein Extension for Short Right Renal Vein Kidney Transplantation
Tony Lu, Stephanie Yi, MD, Jean Bismuth, MD, Ahmed O. Gaber, MD, Richard J. Knight, MD, Carlos F. Bechara, MD.
Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES: Chronic kidney disease is an area of increasing public health concern affecting approximately 1 out of 7 Americans with more than 115,000 new cases of end stage disease annually. Renal transplantation remains the only definitive treatment. Lack of adequate cadaveric organs has increased reliance on living donors. However, right kidney donation has been fraught with problems related to the short renal vein and is associated with higher rates of technical failure and increased complications from artificial extensions. We present here our experience with autogenous internal jugular vein conduits to facilitate right-sided, living donor kidney transplants. METHODS: A series of six patients underwent right-sided, living-donor kidney transplantation with simultaneous right internal jugular vein procurement over a one year period. All had bilateral jugular vein duplex scans preoperatively, and were placed on aspirin 81 mg postoperatively. Patient demographics, comorbidities, and labs were retrospectively queried. Postoperative follow-up and evaluation were performed per institutional protocol. RESULTS: The mean age and BMI were 51 ± 4.6 years and 30 ± 1.4 kg/m2 for the six patients treated. Five of the six had dialysis dependent end stage disease with two receiving peritoneal and three hemodialysis. Major comorbidities were hypertension, dyslipidemia, and diabetes mellitus. An average 4.5 ± 0.5 cm of internal jugular vein was taken, and anastomosed ex-situ, end to end to the renal vein. One patient developed a perinephric hematoma related to kidney biopsy and required re-exploration; there were no harvest site complications or deep vein thrombosis. Jugular vein harvest did not affect renal ischemia time. All had immediate and stable graft function at 3.8 ± 1.7 (range: 0.7-11.3) months follow-up. Mean serum creatinine and estimated glomerular filtration rate were 1.3 ± 0.1 mg/dL and 55 ± 2.4 mL/min/1.73 m2, respectively, at last follow-up. CONCLUSIONS: Internal jugular extension of short right renal veins for kidney transplantation is a viable technique for end stage renal patients with promising short and mid-term results and no added renal ischemia time.
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