SINGLE CENTER EXPERIENCE OF EN BLOC KIDNEY TRANSPLANTATION AND REVIEW OF LITERATURE

Cadaveric renal transplant was started at King FaisalSpecialist Hospital and Research Centre in January 1987. Asthe number of end-stage renal disease patients requiringtransplant was steadily increasing, and the shortage of organswas becoming more severe, we began using cadavericpediatric kidneys in 1989. When the age of the donor was lessthan three years, we used both kidneys together (en bloc) forone recipient.Materials and MethodsFrom 1989 to 1997, we performed seven en bloctransplants from cadaveric donors aged between seven monthsand three years. Five of the seven patients were adults, and twowere pediatric recipients. It was the second transplant in thefirst three recipients. The donor aorta and vena cava weresewn at their proximal ends. The distal end of the aorta wasanastomosed to the external iliac artery and the vena cava tothe external iliac vein. The ureters were sutured to make asingle opening and anastomosed to the bladder as extravesicalureteroneocystostomy (Figure 1).All the patients except Case numbers 3 and 7 receivedquadruple sequential therapy ALG or ATG, prednisone,cyclosporin or FK506 and Imuran or M ycophenolate Mofetil(MMF). The monoclonal antibody OKT3 was used for steroid-resistant rejection. FK506 was used as first-line treatment, oras rescue therapy in resistant rejection. Of late, MMF is beingused as an initial immunosuppression.ResultsCase number 1 received an en bloc kidney transplant in1989, and was given anti-thymocyte globulin (ATG) asinduction. The patient developed two episodes of biopsy-proven rejection at 21 days and at two months, and was givenOKT3 for 10 days. The kidneys never functioned andtransplant nephrectomy was performed on the 68th day. The