Human renal homotransplantation. New surgical technique.

Complications of surgical aspect and which may occur after renal homotransplantation following the classical techniques in the vascular anastomosis as well as in the reestablishment of the continuity of the urinary excretory tract, and which jeopardize the future of a transplanted kidney are analysed. The authors describe the technique followed in a series of cases consisting of the conservation in totum of the receiver's excretory tract (ureter and renal pelvis) performing a pyelo-pyelic anastomosis. No urinary drainage has been used, no catheters, either ureteral or urethral. No \irinary complications were observed of the fistulas, stricture, urinary infection, extravasation, anastomosis dehiscence or ureteral reflux type. Complications of the graft excretory tract of immunological type are thus avoided. The technique to be followed in cases of anomalies in the excretory tract of the donor are also described. Concerning the vascular chapter, instead of the classic reno-iliac venous anastomosis, they perform the reno-cava anastomosis of easier execution which provides a better return circulation and moreover situates the kidney in a better position. They prefer the right kidney particularly if it proceeds from a cadaver. Whichever kidney selected, they situate it in an inverted right lumbo-iliac position. The same method applies for the homotransplantation of an adult kidney to a child. According to the results obtained with this new operating method submitted, a major safety is obtained with better functional results thus allowing the attainment of optima hemo and xirodynamic conditions in the renal homotransplantation while eliminating the postoperative complications which frequently occur when xising the traditional techniques which are the cause of immediate surgical failures and of tardy complications of the renal homotransplant.