Arzu Oezcelik, Gernot M Kaiser, Stefan Becker and Andreas Paul
The number of elderly and multi-morbid patients on the list for kidney transplantation has increased rapidly over the past decade. The presented case is about a 64-year old patient, suffering from chronic kidney disease due to benign nephrosclerosis. After eight years on list for kidney transplantation, a 43-year old deceased donor was accepted and the patient was assigned for kidney transplantation. Intraoperatively the kidney transplantation turned out to be unexpectedly challenging due to severe arteriosclerosis of the recipient iliac vessels while the donor graft quality was excellent. The kidney transplantation was stopped after the second attempt due to repeated intima dissection of the iliac artery. The kidney graft was reperfused with UW-solution after each attempt. After the second attempt the flow of the iliac vessels was compromised. In order to maintain the arterial flow of the iliac vessels, a crossover bypass was required, which was performed without any impairment of the lower extremities’ blood perfusion. The patient could be discharged 12 days after the surgery. The remaining kidney-graft, with total cold ischemic time of 25 hours and total warm ischemic time of 85 (25+35+25) minutes, was transplanted to a 61-years old female patient. The primary graft function was excellent with decreasing serum creatinine level and sufficient diuresis. The doppler-duplex scanning showed good perfusion of the graft. The patient was discharged eight days after transplantation. On the 10-years follow-up, the patients had still an excellent graft function with creatinine value of 1.5 mg/dl. Although one case is not enough to make conclusions, it shows that the transplantation of such kidneygrafts with multiple cold and warm ischemic times to another patient should be considered as an option in these situations.