Objective: The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. Materials and Methods: A total of 14 patients (11 male and 3 female) with a mean age of 47 ± 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. Results: Mean time from injury to RAT was 21.2 ± 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). Conclusion: RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail.

Keywords:
Ureter, Kidney autotransplantation, Kidney, Laparoscopy, Transplantation, Trauma
1.
Hardy JD, Eraslan S: Autotransplantation of the kidney for high ureteral injury. J Urol 1963;90:563-574.
2.
Novick AC, Jackson CL, Straffon RA: The role of renal autotransplantation in complex urological reconstruction. J Urol 1990;143:452-457.
3.
Wotkowicz C, Libertino JA: Renal autotransplantation. BJU Int 2004;93:253-257.
4.
Gordon ZN, Angell J, Abaza R: Completely intracorporeal robotic renal autotransplantation. J Urol 2014;192:1516-1522.
5.
Tran G, Ramaswamy K, Chi T, Meng M, Freise C, Stoller ML: Laparoscopic nephrectomy with autotransplantation: safety, efficacy and long-term durability. J Urol 2015;194:738-743.
6.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
7.
Blacklock AR, Raabe AL, Lam FT: Renal auto-transplantation with interposed PTFE arterial graft: not necessarily a cure for loin pain/haematuria syndrome. J R Coll Surg Edinb 1999;44:134.
8.
Hau HM, Bartels M, Tautenhahn HM, Morgul MH, Fellmer P, Ho-Thi P, Benckert C, Uhlmann D, Moche M, Thelen A, Schmelzle M, Jonas S: Renal autotransplantation - a possibility in the treatment of complex renal vascular diseases and ureteric injuries. Ann Transplant 2012;17:21-27.
9.
Bruce M, Kuan YM: Endoluminal stent-graft repair of a renal artery aneurysm. J Endovasc Ther 2002;9:359-362.
10.
Chiche L, Kieffer E, Sabatier J, Colau A, Koskas F, Bahnini A: Renal autotransplantation for vascular disease: late outcome according to etiology. J Vasc Surg 2003;37:353-361.
11.
Shekarriz B, Lu H, Duh Q, Freise CE, Stoller ML: Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries. Urology 2001;58:540-543.
12.
Han DJ, Han Y, Kim YH, Song KB, Chung YS, Choi BH, Kwon TW, Cho YP: Renal vein extension during living-donor kidney transplantation in the era of hand-assisted laparoscopic living-donor nephrectomy. Transplantation 2015;99:786-790.
13.
Lutz J, Menke J, Sollinger D, Schinzel H, Thurmel K: Haemostasis in chronic kidney disease. Nephrol Dial Transplant 2014;29:29-40.
14.
Bracale UM, Santangelo M, Carbone F, Del Guercio L, Maurea S, Porcellini M, Bracale G: Anastomotic pseudoaneurysm complicating renal transplantation: treatment options. Eur J Vasc Endovasc Surg 2010;39:565-568.
15.
Al-Awadi K, Kehinde EO, Al-Hunayan A, Al-Khayat A: Iatrogenic ureteric injuries: incidence, aetiological factors and the effect of early management on subsequent outcome. Int Urol Nephrol 2005;37:235-241.
16.
Fabrizio MD, Kavoussi LR, Jackman S, Chan DY, Tseng E, Ratner LE: Laparoscopic nephrectomy for autotransplantation. Urology 2000;55:145.
17.
Hodge J: Avulsion of long segment of ureter with Dormia basket. Br J Urol 1973;45:328.
18.
Dickstein RJ, Kreshover JE, Babayan RK, Wang DS: Is a safety wire necessary during routine flexible ureteroscopy? J Endourol 2010;24:1589-1592.
19.
Ulvik O, Rennesund K, Gjengsto P, Wentzel-Larsen T, Ulvik NM: Ureteroscopy with and without safety guide wire: should the safety wire still be mandatory? J Endourol 2013;27:1197-1202.
20.
Bodie B, Novick AC, Rose M, Straffon RA: Long-term results with renal autotransplantation for ureteral replacement. J Urol 1986;136:1187-1189.
21.
Webster JC, Lemoine J, Seigne J, Lockhart J, Bowers V: Renal autotransplantation for managing a short upper ureter or after ex vivo complex renovascular reconstruction. BJU Int 2005;96:871-874.
22.
Benson MC, Ring KS, Olsson CA: Ureteral reconstruction and bypass: experience with ileal interposition, the Boari flap-psoas hitch and renal autotransplantation. J Urol 1990;143:20-23.
23.
Flechner SM, Noble M, Tiong HY, Coffman KL, Wee A: Renal autotransplantation and modified pyelovesicostomy for intractable metabolic stone disease. J Urol 2011;186:1910-1915.
24.
Dagash H, Sen S, Chacko J, Karl S, Ghosh D, Parag P, Mackinnon AE: The appendix as ureteral substitute: a report of 10 cases. J Pediatr Urol 2008;4:14-19.
25.
Ordorica R, Wiegand LR, Webster JC, Lockhart JL: Ureteral replacement and onlay repair with reconfigured intestinal segments. J Urol 2014;191:1301-1306.
26.
Richter F, Stock JA, Hanna MK: The appendix as right ureteral substitute in children. J Urol 2000;163:1908-1912.
27.
Fernandez Fernandez A, Soria Ruiz S, Gomez Martinez I, Gil Fabra J, Martinez Castellanos F, Otero Mauricio G: Blunt traumatic rupture of the high right ureter, repaired with appendix interposition. Urol Int 1994;53:97-98.
28.
Lloyd SN, Kennedy C: Autotransplantation of the vermiform appendix following ureteroscopic damage to the right ureter. Br J Urol 1986;63:216-217.
29.
Estevao-Costa J: Autotransplantation of the vermiform appendix for ureteral substitution. J Pediatr Surg 1999;34:1521-1523.
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2016
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