Kidney Transplant Using a Horseshoe-Kidney Donor at K H Patil Hospital, Hulkoti

The Only Potential Donor Had Unusual Kidney Anatomy

1. The Case

A 42-year-old man needed a kidney transplant. He was the sole earning member of his family, and his wife came forward as the only available potential donor.

During donor evaluation, she was found to have a horseshoe kidney, in which the two kidneys are joined by a bridge of tissue called an isthmus.

This finding added complexity to both kidney donation and transplantation.

2. The Challenge: Joined Kidneys and Additional Blood Supply

The surgical account described:

• A connecting isthmus measuring approximately 2 cm in diameter.

• An accessory artery.

• Arteries positioned far enough apart to require two separate arterial connections during transplantation.

The team needed to account for this anatomy when planning donor surgery and implantation.

3. Evaluation and Counselling

Following evaluation, the team discussed the risks and benefits with the donor and recipient before proceeding.

The decision required an individual assessment of the donor’s anatomy and the feasibility of transplantation.

4. Donor Surgery: Hand-Assisted Laparoscopic Nephrectomy

Dr. Avinash Odugoudar and Dr. Pavan Koliwad performed the hand-assisted laparoscopic donor nephrectomy under the mentorship of Mr. Ajay Sharma from Liverpool.

The operation required careful management of the connecting tissue and the kidney’s blood supply.

5. Transplantation: Two Separate Arterial Connections

During transplantation, the team performed two separate arterial anastomoses—surgical connections between blood vessels—because the arteries were positioned far apart.

This was a key technical consideration in the procedure.

6. What This Case Highlights

The case demonstrates the detailed evaluation and surgical planning involved when a potential living kidney donor has unusual anatomy.

It also highlights the coordination required between donor surgery, recipient surgery, nephrology and anaesthesia teams.

7. A Multidisciplinary Team Effort

Mentorship: Mr. Ajay Sharma, Liverpool

Surgical team: Dr. Avinash Odugoudar and Dr. Pavan Koliwad

Nephrology: Dr. Deepak Kurhatti and Dr. Niyaz Ahmed

Anaesthesia: Dr. Vishal, Dr. Vandana and Dr. Meghana