V8-05: Successful endovascular control of renal artery in a transplant kidney during nephron sparing surgery for large centrally located tumor
Renal cell carcinomas (RCC) which comprise 4.6% of malignant neoplasms in patients following kidney transplantation occurs more frequently than in the general population. Native kidneys are affected in 90% of cases compared with 10% of the transplanted kidneys. _x000D_ Nephron Sparing Surgery (NSS) is the treatment of choice, although graft nephrectomy is chosen in cases with large lesion,decreased functioning graft, and locally advanced disease. One of the main technical challenges is obtaining adequate vascular control._x000D_ Herein we present a rare case of large centrally located hilar tumor in a kidney 18 years after transplantation._x000D_
Open Nephron Sparing Surgery (NSS) is described. Considering possible difficulties in approaching the renal pedicle due to adhesions and the location of the tumor, arterial catheterization of the Iliac artery was performed in the operating room prior to surgery. An arterial occlusion balloon catheter was inserted into the renal transplant artery in order to ensure adequate haemostatic control without the need to expose and clamp the friable transplant renal artery.Under general anesthesia, through the previous right lower abdominal transplant's incision the kidney was exposed and freed from the surrounding structures, the ureter was identified and then the arterial balloon located in the transplant artery was inflated. Surface cooling was achieved with ice slush and the centrally located lesion was enucleated intact and opening of the collecting system as well as exposed blood vessels were individually sutured. Tumor bed closure was carried out with 15 ml of BioGlue® tissue adhesive. After the enucleation the arterial balloon was deflated. No signs of bleeding or urinary extravasations were seen.
Post-operative course was uneventfull, and after one year of follow-up no recurrence was observe an serum creatinine is stable and slightly elevated.
we demonstrate an unusual case of renal cell carcinoma in transplanted kidney managed by NSS despite the lesion high RENAL score. A novel approach was used to achieve vascular control by using intra arterial balloon catheterization prior to surgery. In order to preserve maximal function tumor bed closure was made with tissue adhesive BioGlue®. We believe that this unique choice of treatment can be used in cases of NSS where the access to the renal pedicle is limited.
Funding: CryoLife LTD