Technique of Renal Homotransplantation

Abstract

Purely technical considerations play asignificant role in successful renal homotransplantation. Minimization of homograftischemia is critical. If blood supply to thecooled homograft can be restored within 40minutes, prompt urinary excretion can beexpected to follow. Longer periods of devascularizationresult in inconsistent earlyfunction. Even with ischemie intervals ofless than 40 minutes, there is an inverse correlation between the times necessary for vascular reconstruction and the quality of earlyrenal function.Additional important technical factors involve the site of placement of the homograft,provision for unkinked vascular channels,selection of a method of ureteroneocystostomywhich permits early removal of theurethral catheter, avoidance of all drains,and use of a one-stage operation incorporathemorrhage, diabetes mellitus, pancreatitis,thromboembolism, and neurologic disorders.The high incidence of such appears to be due to the high dose immunosuppressive therapy necessary to maintainviability of the homograft during the rejection crisis, to the terminal uremia which all patients are suffering at the timeof operation, and to specific elements of thetotal operative care such as splenectomy andinstrumentation of the pelvic veins. © 1964 IEEE All rights reserved.