Introduction

More than 100,000 patients are on the kidney transplant waiting list and the increasing number of patients without living donor options underscore why it is important to decrease the discard rate of deceased donor kidneys available for transplantation.1

In the March/April 2012 issue of the Journal of the National Medical Association, kidney transplant surgeons and urologists at Cleveland Clinic described surgical techniques to reduce discard rates of kidneys from renal allografts with significant capsular defects resulting from procurement.2


Case 1: Vicryl Mesh Repair

A 49-year-old male Jehovah’s Witness who refused blood transfusions was admitted to receive a renal allograft imported to Cleveland Clinic from a transplant program in a neighboring state. The program refused to use the allograft due to multiple arteries. Upon inspection of the allograft it was also noted that two-thirds of the renal surface was devoid of capsule.

The kidney capsule was repaired at Cleveland Clinic by covering the surface of the denuded renal allograft with Vicryl mesh, which acted as a capsule replacement (Figure 1).  The Vicryl mesh was trimmed to match the size of the defect and the edges sutured to the capsule with 3-0 chromic catgut. Evicel, a fibrin sealant, was applied over the mesh to provide further reinforcement. The kidney was then successfully transplanted with no postoperative bleeding. More than two years later, the graft continues to function well.