Stroomsa et al developed an algorithm to help guide transplantation of a horseshoe kidney. This can help optimize its use while reducing the risk of technical failure. The authors are from Maastricht and Leiden in The Netherlands.
Options for handling a horseshoe kidney available for transplant:
(1) rejection as unsuitable
(2) split into 2 kidneys: best for essentially separate kidneys with parenchymal fusion at one pole
(3) en bloc transplantation:
Issues affecting horseshoe kidneys:
(1) Obstruction at the ureteropelvic junction (UPJ) is common and can result in recurrent infection and a predisposition to renal stones.
(2) Both the arterial and venous vasculatures may be highly complex, with numerous anomalies that can make the surgery technically difficult.
Questions:
(1) Is there evidence of ureteropelvic junction (UPJ) obstruction?
(2) Does the urinary collecting system cross the midline?
(3) Is the vascular anatomy high risk for technical failure (due to complexity of the blood supply)?
UPJ Obstruction
Urinary Collecting System Crossed Midline
Vascular High Risk
Transplant Procedure
Yes
NA
NA
do not transplant
N
Y
NA
en bloc
N
N
Y
en bloc
N
N
N
split transplant
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