The transplantation of difficult donor kidneys and recipients: helpful surgical techniques.

Due to the current shortage of organ donors a coalescence of surgical techniques has been applied in an attempt to use all compatible organs that may have been discarded due to anatomical variations, disease or damage, and to transplant them into higher surgical risk recipients. Selected cases have been chosen that illustrate some of these techniques, and the various types of recipients and donor kidneys. Cases 1 and 2 illustrate applications of the orthotopic technique of renal transplantation, as well as reconstructive measures that may be necessary for success. Renal transplantation in perhaps one of the more commonly encountered difficult recipients, the patient with severe atherosclerotic vascular disease, is addressed by cases 1 and 3. The use of unusual donor organs, such as horseshoe kidneys and pediatric donor en block kidneys, is particularly pertinent in the attempt to transplant all viable organs and is demonstrated in cases 4 and 5. These cases illustrate the application of various surgical techniques in which either a difficult recipient or a damaged and/or diseased donor kidney may have otherwise precluded renal transplantation.