A TECHNIQUE FOR USE OF ADULT RENAL HOMOGRAFTS IN CHILDREN.

Abstract

Renal transplantation as originally described by Kuss and later refined by Murray and Harrison has proved to be an effective operation from a technical point of view. The donor kidney is placed in the contralateral iliac fossa of the recipient, and thereby the anteroposterior relations of the hilar structures are reversed. The renal vessels are attached to the end and side, respectively, of the hypogastric artery and the external iliac vein. Urinary drainage is provided with ureteroureterostomy or a ureteroneocystostomy. In children, the use of this simple extraperitoneal operation is inconvenient or impossible if an adult kidney is used, because the large homograft may not fit into the relatively diminutive iliac fossa. In addition, the size of the pelvic vessels may be so small compared with those of the homograft that an unfavorable disparity can create additional hazards. Recently, these problems have been considered in 3 children who were treated with renal homografts from their mothers. The patients were 8, 6, and 3 years old, and weighed 22.5, 20, and 15 kilograms respectively. A previously undescribed method was employed for transplantation. The present report is concerned with a description of the operative technique. In addition, observations are included on the hemodynamic consequences of revascularizing a large kidney in a host who would have to contribute a disproportionately large fraction of cardiac output to the relatively oversized new organ.