When it comes to kidney disease and disorders, there are many treatment options available, ranging from medications to minimally invasive outpatient procedures and inpatient surgery. While most are quite effective in their own right, there are unique situations in which renal autotransplantation can be considered. Thus, renal autotransplant surgery is typically an option that offers hope when all other treatment types have been exhausted or do not exist.
Renal autotransplant (also known as renal autotransplantation or renal reimplantation) is a kidney-saving surgery that can be used in select patients. During the procedure, the kidney and ureter are removed and the kidney is then implanted—or placed—in a different part of the body, typically in the pelvis adjacent to the bladder. If the surgery is successful, the patient benefits from having two functioning kidneys even though one has been moved to a different location in the body.
Although they share the same terminology and essentially the same surgery, a kidney transplant and renal autotransplant are not the same thing. With a kidney transplant, a donor kidney from either a deceased or living donor is placed into the recipient, and immunosuppression is needed so the kidney is not rejected. With a renal autotransplant, the patient’s own kidney is removed and then transplanted back into the same patient, so immunosuppression is not needed.
Renal autotransplant is an effective treatment for some patients, including situations in which other treatment options have been exhausted. Although a rare procedure, renal autotransplant has been shown to offer good outcomes while preserving renal function in cases of Nutcracker Syndrome, loin pain hematuria syndrome, vascular malformations, kidney stones, and kidney cancer. Because this surgery is generally not an option for all patients, your UCHealth team is multidisciplinary and has expertise in several different areas, including urology, interventional radiology, transplant surgery, psychiatry (behavioral health), addiction medicine, and social work. Together, they can assess each patient’s situation to determine if renal autotransplant is the right procedure for them.
The surgery typically lasts between 4-8 hours, but times can vary. To start, a small rubber tube is placed into the bladder to help track urine output, and this remains in place for 3-7 days.
There are two main ways to perform the surgery. One involves a large incision in the middle of the abdomen to remove the kidney and then move it to a different part of the body. The other way involves a minimally invasive approach using either a small camera and small working ports or a surgical robot. The minimally invasive approach is generally the preferred method due to less blood loss, less pain, and a much quicker recovery.
Once the kidney has been removed, it is flushed with anticoagulation and preservation solutions in ice. The new location for the kidney is prepared and the kidney is placed in this new location by reconnecting the blood vessels of the kidney. Lastly, a new connection from the ureter to the bladder is made and a very fine tube (stent) is placed in the ureter to make sure the ureter stays open during recovery. This stent will stay in place for about 4 weeks after surgery. The typical hospital stay ranges from 3 to 7 days.