18 - Surgical issues of renal and renal/pancreas transplantation in pregnancy

Summary

Introduction

Both renal and pancreatic transplantation have increased during the past few decades and thus the potential complications associated with pregnancy, and indeed the care of women during pregnancy and delivery, requires careful management. In 2006 within the UK there were 416 cases of renal transplantation in women of childbearing age and 51 cases of renal/pancreas transplantation. Knowledge of the surgical procedures performed at transplantation can have important implications for the woman's care, particularly if a caesarean section is required.

Renal transplantation

The transplanted kidney is placed extraperitoneally in the false pelvis, lying lateral or anterior to the iliac vessels. The renal artery and vein are commonly anastomosed to the external iliac vessels in an end-to-side configuration. The transplant ureter crosses the external iliac vessels, usually close to the inguinal ligament and anastomosed to the most convenient place on the bladder, i.e. anterior and lateral.

In paediatric renal transplantation for recipients of less than 20 kg, the kidney is anastomosed to the aorta and vena cava. The transplant is placed behind the ascending colon and the ureter runs down to the bladder adjacent to the native ureter above the pelvic brim. The vesicoureteric anastomosis, though, is likely to be closer to the midline and more anterior on the bladder. Thus the transplant ureter is at a greater risk with subsequent pelvic surgery.