Criteria for an ideal deceased kidney donor?
- Normal renal function
- No hypertension requiring treatment
- No diabetes mellitus
- No malignancy other than a primary brain tumor or treated superficial skin cancer
- No generalized viral or bacterial infection
- Acceptable urinalysis
- Age between 6 and 50 years, and
- Negative assays for syphilis, hepatitis, HIV, and human Tlymphoproliferativevirus.
Mechanism of cell injury in warm ischemia?
- Warm ischemic injury is due to failure of oxidative phosphorylation and cell death due to adenosine triphosphate (ATP) depletion.
- ATP is required for the cellular sodium-potassium pump to maintain a high intracellular concentration of potassium and a low internal concentration of sodium.
- When the sodium-potassium pump is impaired, sodium chloride and water passively diffuse into the cells, resulting in cellular swelling and the “no-reflow” phenomenon after renal revascularization. Cellular potassium and magnesium are lost, calcium is gained, anaerobic glycolysis and acidosis occur, and lysosomal enzymes are activated. This results in cell death.
- During reperfusion, hypoxanthine, a product of ATP degradation, is oxidized to xanthine with the formation of free radical scavengers that cause further cell damage
Principles of Simple Cold Storage of Kidneys
- Cellular energy requirements are significantly reduced by hypothermia.
- This is done by surface cooling, hypothermic pulsatile perfusion, or flushing with an ice cold solution followed by cold storage.
- Making the flush solution slightly hyperosmolar with impermeant solutes such as mannitol, lactobionate, raffinose, or hydroxyethyl starch helps prevent endothelial cell swelling and the “no-reflow” phenomenon.
- Calcium channel blockers, xanthine oxidase inhibitors,free radical scavengers, vasoprotective agents, and lysosome stabilizers such as methylprednisolone have all been used to reduce ischemic injury.
Indications of open doner nephrectomy?
The role of open donor nephrectomy has been diminished in the past 10 yr owing to the development of laparoscopic donor nephrectomy.
- Indications of open donor nephrectomy -
- - extensive prior intraperitoneal surgery
- - a very short right renal vein (<1.5 cm).
In right laparoscopic donor nephrectomy, the right renal vein is transected at the level of the inferiorvena cava (IVC), without the cuff of 1VC that is traditionally obtained in an open donor nephrectomy.
Advantages of open donor nephrectomy?
- No issues of pneumoperitoneum-induced renal dysfunction, warm ischemia,or shortened renal vessels (particularly right-sided procurements),compared with laparoscopic donor nephrectomy
Triangular territory of the ureteral vasculature?
- The triangle of tissue bordered
- - laterally by the lower pole of the kidney
- - medially by the IVC and
- - superiorly by the renal hilum