Renal Autotransplant as a Rare but Ideal Treatment for Certain Indications

The University of Maryland Medical Center (UMMC) has assembled a multidisciplinary team capable of treating vascular and ureter anomalies that have the potential to necessitate a renal autotransplant. These conditions include renal vascular disease, nutcracker syndrome, pelvic venous congestion, pelvic trauma, refractory stone disease and, in some cases, loin pain hematuria syndrome and kidney cancer. To manage the severe pain some of these conditions can cause, after failed medical therapy, definitive treatment options such as renal autotransplant could be considered eventually.

UMMC is one of the nation's largest program in kidney transplant, and in the past its surgeons have occasionally offered renal autotransplant as situations have warranted. However, the UMMC transplant team is poised to become a regional leader in this area with the July 2018 addition of Talal M. Al-Qaoud, MBChB, FRCSC, Assistant Professor of Surgery at the University of Maryland School of Medicine (UMSOM) and a transplant surgeon with specialized training in urology. Dr. Al-Qaoud joins Joseph R. Scalea, MD, Assistant Professor of Surgery at UMSOM, who also performs renal autotransplant at UMMC. Both surgeons completed fellowships in transplant surgery at the University of Wisconsin Hospitals and Clinics, a national leader in renal autotransplantation.

Only a handful of transplant programs in the United States offer renal autotransplant, in which surgeons remove a kidney with vascular or ureter malformations, correct the organ's mechanical issues and then transplant it back into the patient's pelvis next to the bladder. There are no long-term safety concerns about the kidney's new placement; University of Maryland trauma and transplant surgeons undertook a retrospective study that demonstrated that transplanted organs handle trauma just as well in their new context as they would in the thorax¹. At UMMC, an autotransplant can often be done with a single midline incision, with a hybrid laparoscopic procedure to retrieve the organ.

While the kidneys are redundant organs, preserving both of them is often important for a patient's future quality of life. Coupled with the fact that receiving back one's own kidney does not require immunosuppression, renal autotransplant is the ideal treatment for some patients after a correct diagnosis is made and other options have been exhausted.

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