Feasibility of renal transplantation after unroofing of a large renal cyst in an expanded criteria donor
The patient was a 61-year-old male with a history of high blood pressure, who subsequently developed renal failure, and had been undergoing hemodialysis for 3 years before he received a renal transplant. The deceased donor was a 62-year-old male with a 2-year history of hypertension, and cerebrovascular accident was the cause of death. The deceased donor kidney was noted to have a large cyst abutting the main renal artery [].\nThe allograft essentially met the expanded criteria for renal transplantation.[] There was a 1-antigen match in the HLA-DR locus. T and B-lymphocyte crossmatches were negative. The allograft was then prepared for transplantation; the large cyst was unroofed []. The frozen section revealed a benign simple cyst. The graft kidney weighed 340 g with very mild arteriosclerosis and fibrosis, and 3% glomerulosclerosis. The edges were oversewn with a 4-0 PDS suture material; Evicel™ was applied to the base, and the two biopsy sites were oversewn with 5-0 Prolene sutures. The allograft was then transplanted in the usual fashion uneventfully: the renal artery to the external iliac artery and the vein to the external iliac vein.\nThe patient was induced with thymoglobulin and daclizumab. Thymoglobulin (1 mg/kg) was given intraoperatively, with similar additional postoperative doses on days 3 and 5. The first dose of daclizumab (1 mg/kg) was also given intraoperatively, with one additional dose 14 days later. Tacrolimus was initiated at a dose of 0.1 mg/kg twice daily after the renal function had improved, i.e. the serum creatinine concentration decreased to <4 mg/dl in the absence of dialysis. The target (12 h) trough level of tacrolimus was 4-6 ng/ml. The target mycophenolatemofetil dose was 1 g twice daily. Methylprednisolone was given intravenously at 500 mg per day for 3 days postoperatively, with subsequent weaning to complete withdrawal after the first postoperative week; steroid avoidance.[]\nThe postoperative course was uneventful. The patient was discharged with excellent urine out, and at 22 months, the serum creatinine level was 1.4 mg/dl.