Recipient Candidates Renal Autotransplantation for the Treatment of Complex Renovascular Hypertension S. Sevmis, H. Karakayali, F. Boyvat, C. Aytekin, and M. Haberal ABSTRACT Objective. In individuals with complicated renal vascular disease, renal autotransplan- tation has been used as an alternative to percutaneous transluminal angioplasty, which may be unsuccessful or hazardous in these situations. We evaluated the outcomes of renal autotransplantation. Patients and Methods. Between February 1989 and December 2005, we performed 5 renal autotransplantation procedures. The surgical strategy included renal explantation, ex vivo renal preservation, ex vivo reconstruction of the renal artery if necessary, and renal heterotopic autotransplantation. Results. The study subjects (3 men and 2 women) exhibited one of the following indications for surgery: fibromuscular dysplasia (2 patients), Takayasu’s arteritis (1), or atherosclerosis (2). All patients exhibited uncontrolled hypertension before renal auto- transplantation. Renal arteries of patients were anastomosed either to the external or internal iliac arteries or to both when there were multiple renal arteries. The renal vein was anastomosed end-to-side to the external iliac vein, and ureteral reimplantation was not performed. Mean posttransplantation follow-up was 9.8  5.7 years (range, 1–16 years). Mortality and morbidity were not observed during the follow-up, and hypertension and renal function normalized or improved in all 5 patients. Conclusions. Renal autotransplantation is a highly effective procedure to treat complex renovascular lesions; ex vivo renal repair is a safe and effective surgical procedure in the clinical setting. P ERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) is the preferred first-order treatment for isolated stenosis of the renal artery caused by fibrodysplasia or atheroscle- rosis. 1 When PTA is unsuccessful or is not possible because of the hilar location of a pathologic vascular condition or the presence of an inflammatory disease such as Takayasu’s arteritis, renal autotransplantation is an alternative procedure that has been used for more than 30 years. 2 The manipulation of renovascular lesions may lead to ischemic injury. Although a vascular clamping duration of 20 minutes has been reported to be safe, even shorter clamping periods may cause acute renal failure. To prevent ischemic injury to the kidneys, methods such as selective perfu- sion of the renal arteries with preservation solutions, after ne- From the Department of General Surgery, Baskent University, Ankara, Turkey. Address reprint requests to Mehmet Haberal, MD, FACS, FICS (Hon), Department of General Surgery, Baskent University, 1 Cadde No. 77 Kat 4, Bahcelievler, Ankara 6490, Turkey. E-mail: rektorluk@baskent-ank.edu.tr 0041-1345/06/$–see front matter © 2006 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2006.10.143 360 Park Avenue South, New York, NY 10010-1710 3412 Transplantation Proceedings, 38, 3412–3415 (2006)