Ann Surg Treat Res.  2016 Nov;91(5):260-264. 10.4174/astr.2016.91.5.260.

Clinical importance of congenital anomalies of the inferior vena cava in organ procurement surgery from a deceased donor: two case reports

• Kim MH
• Jun KW
• Moon IS
• Kim JI

• KMID: 2356377
• DOI: http://doi.org/10.4174/astr.2016.91.5.260

Abstract

Congenital anomalies of the inferior vena cava (IVC) are rare but important problems in living donors for kidney transplantation, especially in cases of a short left renal vein and accompanying vascular and urological anatomic variations. However, the clinical impacts of IVC anomalies in deceased donors have yet to be reported. The unexpected presence of an IVC in an unusual position poses challenges to surgeons and increases the risk of bleeding during organ removal. Accompanying vascular variations can cause unexpected bleeding and injury and therefore technical complications in procurement and subsequent implantation. During cold perfusion, inadequate venous drainage or insufficient cooling can induce graft damage. Our cases highlight the need for all transplant surgeons to confirm the anatomy of the aorta, IVC, and major vessels early in the surgical procedure and, should an anomaly be detected, know how to manage the problem.

Keyword

Kidney transplantation; Tissue and organ procurement; Intraoperative complications; Anatomic variation; Inferior vena cava

MeSH Terms

Anatomic Variation
Aorta
Drainage
Hemorrhage
Humans
Intraoperative Complications
Kidney Transplantation
Living Donors
Perfusion
Renal Veins
Surgeons
Tissue and Organ Procurement*
Tissue Donors*
Transplants
Vena Cava, Inferior*

Figure

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  Fig. 1 Kidneys from deceased donor with left-sided inferior vena cava (IVC). (A) Renal grafts after en bloc procurement. Left-sided IVC joined the left renal vein and crossed the aorta anteriorly and then joined the right renal vein. Left renal vein was shorter than the right one. Both kidneys had a single artery. (B) The left kidney was procured together with the IVC. The left renal vein is extended during a back-table procedure using the IVC. L, left-sided IVC; Ao, aorta; SMA, superior mesenteric artery; LK, left kidney.

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  Fig. 2 Kidneys from deceased donor with double inferior vena cava (IVC). (A) Right IVC and second left IVC were identified. Left IVC crossed the aorta just after its union with the left renal vein and then joined the right IVC to form a single, right-sided IVC. The right kidney had double renal arteries (arrow, inferior polar artery arising from aorta) but there were no other anatomic variations. (B) Right kidney after back-table procedure. Right renal vein is extended with IVC. R, right-sided IVC; L, left-sided IVC; Ao, aorta; RK, right kidney.

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