Segmental Renal Ischemia following Transplantation of Horseshoe Kidney as Separate Allografts

Introduction. Horseshoe kidney is a congenital anomaly that presents unique challenges for the transplant surgeon. The mere presence of horseshoe kidney should not preclude consideration for transplantation. Case Report. A 33-year-old women suffering from end-stage renal disease underwent deceased donor renal transplant with a divided horseshoe kidney. We present a postoperative complication and the technical strategy for transplant salvage. The patient currently has excellent graft function. Discussion. Horseshoe kidneys do present challenges for successful transplantation. Though case reports of successful transplantation are increasing, we present a technical complication and successful transplant salvage strategy. Technical descriptions in the literature of successful back-table preparation strategies should help more transplant surgeons to begin to utilize this resource. Conclusion. This study concludes that horseshoe kidneys can be successfully used for transplantation and provides a technical strategy to salvage the transplant after a unique complication associated with these donor kidneys. 1. Introduction Horseshoe kidney is a congenital anomaly found in approximately 1 in 400 persons. With 6,000 to 8,000 deceased donors per year in the United States, utilization of horseshoe kidneys for renal transplantation would afford more organs for transplant recipients. The first case reports of transplanted horseshoe kidneys were described in 1975 by Nelson and Palmer [1]. A recent review found only 55 reported cases of transplanted horseshoe kidney in the literature [2]. Of these cases, 15 were transplanted en bloc. Two were split horseshoe kidneys from living donors, and the remaining 38 were split from cadaveric donors and then transplanted. Several factors must be considered when deciding to utilize a horseshoe kidney for transplantation including renal size (a surrogate for nephron mass), renal vascular anomalies, and urologic anatomy. Only one-third of horseshoe kidneys have normal renal arterial supply [2]. As the kidney is supplied by functional end arteries, failure to preserve inflow to the kidney will result in ischemia. We report a unique urological complication encountered in one of the two renal transplant recipients related to aberrant blood supply in a horseshoe kidney. 2. Case Report 2.1. Donor Anatomy and Surgery The kidneys from a 55-year-old donor following a cerebrovascular accident and brain death were accepted for transplantation. The donor had a congenital horseshoe kidney and normal creatinine (0.8？mg/dL). Each half of the