Kidney transplant In most cases the barely functioning existing kidneys are not removed, as removal has been shown to increase the rates of surgical morbidity. Therefore, the kidney is usually placed in a location different from the original kidney. Often this is in the iliac fossa so it is often necessary to use a different blood supply: * The renal artery of the new kidney, previously branching from the abdominal aorta in the donor, is often connected to the external iliac artery in the recipient. * The renal vein of the new kidney, previously draining to the inferior vena cava in the donor, is often connected to the external iliac vein in the recipient. The donor ureter is anastomosed with the recipient bladder. In some cases a ureteral stent is placed at the time of the anastomosis, with the assumption that it allows for better drainage and healing. However, using a modified Lich-Gregoir technique, Gaetano Ciancio developed a technique which no longer requires ureteral stenting, avoiding many stent related complications. There is disagreement in surgical textbooks regarding which side of the recipient's pelvis to use in receiving the transplant. Campbell's Urology (2002) recommends placing the donor kidney in the recipient's contralateral side (i.e. a left sided kidney would be transplanted in the recipient's right side) to ensure the renal pelvis and ureter are anterior in the event that future surgeries are required. In an instance where there is doubt over whether there is enough space in the recipient's pelvis for the donor's kidney, the textbook recommends using the right side because the right side has a wider choice of arteries and veins for reconstruction. Glen's Urological Surgery (2004) recommends putting the kidney in the contralateral side in all circumstances. No reason is explicitly put forth; however, one can assume the rationale is similar to that of Campbell, i.e. to ensure that the renal pelvis and ureter are most anterior in the event that future surgical correction becomes necessary. Smith's Urology (2004) states that either side of the recipient's pelvis is acceptable; however the right vessels are 'more horizontal' with respect to each other and therefore easier to use in the anastomoses. It is unclear what is meant by the words 'more horizontal'.
Kidney transplantation
Artificial kidney
Intestine transplantation
Renal replacement therapy
Islet cell transplantation
Iridodialysis
Distal splenorenal shunt procedure
Dialysis