PMC6442374_01
Renal system in situ. Macroscopic view of the renal system within the abdominal cavity of the donor. AA = abdominal aorta, CIA = common iliac artery, IMA = inferior mesenteric artery, IVC = inferior vena cava, RA = renal artery, RP = renal pelvis, RV = renal vein, U = ureter. Image scale bar = 2 cm.
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fig1
Hilar structures entered/exited the organs anteriorly, not with the typical medially projected hilum (Figure 1). Both ureters continued inferiorly and independently to enter the bladder (Figure 1).
Ex situ renal system exhibits anatomical variations from normal pattern. (a) Uncolorized renal system ex situ. (b) Arterial network pseudocolorized in red. rsRA = right superior renal artery, lsRA = left superior renal artery, IMA = inferior mesenteric artery, riRA = right inferior renal artery, lmRA = left middle renal artery, liRA = left inferior renal artery, rCiRA = right common iliac artery, lCiA = left common iliac artery. (c) Venous network pseudocolorized in blue. IVC = inferior vena cava, rsRV = right superior renal vein, lsRV = left superior renal vein, riRV = right inferior renal vein, liRV = left inferior renal vein. (d) Ureters pseudocolorized in yellow with rRP = right renal pelvis, lRP = left renal pelvis, rU = right ureters, lU= left ureter. Pseudocolorization created using Adobe Photoshop. Image scale bar = 2 cm.
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A total of five major arteries (3l and 2r) emerged from the aortic and common iliac axes (Figures 2(a) and 2(b)). Supply to the left gonad originated from the more inferior of these two branches (Figures 2(b) and 3(b)). Multiple contributing veins, of different caliber, coalesced into four major renal veins (2l and 2r) that returned blood from the kidneys to the IVC (Figure 2(c)). Venous return from the left gonad ultimately merged into the most inferior branch of the three primary contributors to the superior renal vein (Figures 2(c) and 3(b)). Unilateral duplication of the kidney with concomitant ureters was evident for the right side (Figure 2(d)).
Ex situ left kidney exhibits anatomical variations. Anterior (a, b) and posterior (c, d) views of the left kidney. Arterial, venous and ureteric systems (b, d) are pseudocolorized in red (arterial), blue (venous) and yellow (ureteric). Renal veins (lsRV, liRV) are reflected to better illustrate the arterial pattern. Image scale bar = 2 cm.
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The middle left renal artery (6.1 mm diameter) originated from the iliac junction, just anterior to the median sacral artery (Figures 3(a) and 3(b)). The inferior left renal artery (5.4 mm diameter) originated from the common iliac artery, and coursed posteriorly to the kidney before entering the hilum anteriorly (from the lateral aspect of the organ), to supply the inferior pole (Figures 3(b), 3(c), and 3(d)). A visible and substantive anastomotic connection was evident between the superior and inferior venous pathways (Figure 3(b)). On the contralateral side, the single ureter emerged from a widened and anteriorly projected hilum (Figure 3(b)).
Ex situ right kidney exhibits anatomical variations. Anterior (a, b) and posterior (c, d) views of the right kidney. Arterial, venous, and ureteric systems (b, d) are pseudocolorized in red (arterial), blue (venous), and yellow (ureteric).
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fig4
As with the contralateral side, this artery also branched into two vessels of similar caliber, but supplied the superior half of the organ (Figures 4(a) and 4(b)). Arterial supply to the inferior pole (6.5 mm diameter) originated on the lateral aorta, at a level inferior to the inferior mesenteric artery, and branched into two arteries (Figures 4(b), 4(c), and 4(d)). As on the contralateral side, a visible and substantive venous anastomotic connection was evident between the superior and inferior aspects of the kidney (Figure 4(b)). The majority of the superior renal pelvis was positioned posterior to the vasculature (Figures 4(a) and 4(b)).