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Introduction:
Currently, there is a discrepancy in the number of kidney transplant donors and recipients. While the kidney has discrete segmental vasculature that can divided as in partial nephrectomy, partial kidney transplant is not a currently used modality. We sought to develop a partial kidney transplant porcine model.
Materials & Methods:: Adult 200lb swine were selected because of similar renal vasculature to humans. Using a robotic approach, the segmental renal vessels to the upper and lower pole were dissected. After systemic heparin was administered, the upper pole vessels were selectively clamped and an upper pole heminephrectomy was performed. The lower pole was reconstructed and the upper pole was autotransplanted to the pelvis after flushing with heparinize saline intracorporally. The internal iliac vessels were used as donor vessels. Both artery and vein anastomoses were performed in an end-to-end fashion. A calicovesicostomy was performed for the urinary anastomosis. The end point of this pilot study was vascular perfusion of the donor moiety.
Results:
A total of 10 non-survival surgeries were performed. Systemic heparinization was not utilized in the first two cases and the donor kidney clotted before the anastomoses were completed. In the final 8 cases with adequate anticoagulation, the donor moiety reperfused after the vascular anastomoses were completed. Mean operative was 4:15 hours and mean vasculature anastomosis time was 40 minutes.
Conclusions:
In this pilot study, partial kidney transplant appears to be technically feasible in a porcine model. Future work will investigate post-operative recovery of renal function