Kidney autotransplantation for renal artery aneurysm: case series and a systematic review.

OBJECTIVES: Renal artery aneurysm (RAA) is a rare vascular disease. Kidney autotransplantation (KAT) is the treatment option when endovascular approach is not available. However, the evidence on KAT for RAA is mostly limited to small case series or reports. Here, we describe our two-center experience of KAT for RAA, and provide the results of our systematic literature review to evaluate the outcomes.

METHODS: A retrospective two-center study was conducted in patients undergoing KAT for RAA between 2010 and 2018. Moreover, a systematic review was performed on medical databases to evaluate the outcomes of KAT for RAA.

RESULTS: Nine patients were surgically treated at our institutions: eight with laparoscopic nephrectomy (LN), and one with open followed heterotopic KAT. All RAAs were ex-vivo reconstructed, and in three cases a vein graft was used for reconstruction. There were two postoperative major complications including one graft loss. In the systematic review, 102 studies with 355 patients were included. In 35 patients (9.9%) a minimal invasive approach was performed. The incidence of postoperative major complications and graft loss was 9.4% and 4.1%.

CONCLUSIONS: Our experiences showed that laparoscopic approach for nephrectomy followed heterotopic KAT was feasible with good postoperative outcomes. KAT is an effective treatment for RAA when endovascular approach is not feasible for interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.