What Is Renal Autotransplant (RAT)?

Autotransplant surgery

Renal autotransplant is a type of surgery that helps patients manage severe, long-lasting kidney pain. During the procedure, transplant surgeons remove the kidney that's causing pain and implant—or place—this kidney in a different part of your body.

Even though one of your kidneys has been moved to a different location in your body, your body still works normally because it has two healthy kidneys.

What Happens During Renal Autotransplant Surgery?

During a renal autotransplant procedure, surgeons use a type of minimally-invasive surgery called laparoscopy to make small cuts (or incisions) to view the inside of your abdominal wall. Surgeons use specialized instruments and a camera to help remove your kidney.

After your kidney is removed, surgeons flush the blood from your kidney and then cool it down with a special solution so your kidney stays preserved. Surgeons then place your kidney in a new spot in your pelvis, next to your bladder.

Moving the kidney to another part of your body severs—or breaks—your kidney's connection with nerves. This causes the pain to stop. 

Protecting Your Kidneys During Cardiac Surgery

Some patients also choose to have renal autotransplant surgery to protect their kidneys during cardiac surgery or thoracoabdominal aneurysm surgery. Having renal autotransplant surgery during these procedures protects your kidneys, allowing them to work normally after your surgery.

Treating Kidney Pain With Renal Autotransplant Surgery

Some patients decide to have renal autotransplant surgery to relieve chronic (long-lasting) pain caused by the following conditions:

Treating Kidney Stones

If you have kidney stones, renal autotransplant surgery eliminate your ureter pain. Your ureters are narrow tubes where urine travels from your kidneys to your bladder.

If you have kidney stones, the stones also travel through these tiny tubes, causing excruciating pain.

During RAT surgery, surgeons can shorten the length of your ureter. Normal ureters are about 20 cm long. But during surgery, your surgeon will shorten your ureters down to just 3 cm.

Even though your body still produces kidney stones after RAT surgery, these stones have a much shorter distance to travel. You also don't feel them because your nerves have been removed. This can make pain from kidney stones much less intense.

Loin Pain Hematuria Syndrome

What Is Loin Pain Hematuria Syndrome?

Loin pain hematuria syndrome (LPHS) is a condition that causes severe, long-lasting pain around your flanks. Your flanks include your:

  • back,
  • sides, and
  • the upper part of your belly.

Loin pain hematuria syndrome can happen if you have chronic injuries to your kidneys, usually caused by kidney stone disease or other illnesses.

Loin pain hematuria syndrome can also be very difficult to diagnose. Some doctors mistake it for other conditions. To diagnose it correctly, your doctor will first need to rule out other urology and kidney conditions.

Because the pain from LPHS lasts a long time, having this condition can lower your quality of life, making it difficult to work or go to school. Some people with LPHS develop addictions to prescription pain killers.

Treating Loin Pain Hematuria Syndrome With Renal Autotransplant

There are only two treatments for loin pain hematuria syndrome:

  1. Nephrectomy (removing one or both of your kidneys)
  2. Renal autotransplant

For many patients with loin pain hematuria syndrome, having RAT surgery is a better option. That's because unlike having a nephrectomy, renal autotransplant lets you keep both of your kidneys.

Renal autotransplant surgery is also successful at making the pain go away. One year after surgery, most patients report pain at one rather than eight (on a one to 10 scale). Their quality of life is hugely improved.

Nutcracker Syndrome

What Is Nutcracker Syndrome?

Nutcracker syndrome is a disorder where the renal vein has pressure on it. For people with Nutcracker syndrome, their left renal vein gets compressed (squeezed) between the superior mesenteric artery (SMA) and aorta. Renal veins drain blood from your kidneys after your kidneys filter and clean your blood.

Nutcracker syndrome can cause pressure to build up inside your renal veins. This pressure can cause your gonadal and pelvic veins to dilate (or get larger), causing you pain. If this happens, blood can appear in your urine (also called haematuria).

Treatments

There are three treatments for nutcracker syndrome:

  1. Left gonadal vein transposition/veinous transposition
  2. Left nephrectomy (some patients have opted to donate their kidney to the kidney transplant waitlist)
  3. Left renal autotransplant

For many patients with nutcracker syndrome, having renal autotransplant surgery offers a more effective treatment while letting you keep both of your kidneys.

RAT surgery is successful at making the pain go away and relieving the symptoms of nutcracker syndrome without disrupting kidney function (affecting how your kidneys work inside your body).

Abdominal Compression Syndromes

These additional syndromes may occur along with nutcracker syndrome:

  • SMA
  • MALS
  • May Thurner syndrome
  • POTS

Who's Eligible?

Renal autotransplant is only an option for patients with severe kidney pain that hasn't improved with other treatments.

Our multidisciplinary team will review your medical issues and symptoms to help you determine if RAT is the best option.

Why Choose University of Utah Health

Because renal autotransplant is only an option for people who've tried other treatments, it's important that your multidisciplinary team encompasses different areas of medicine to make sure that renal autotransplant is the best treatment option for you.

To correctly diagnose loin pain hematuria syndrome or nutcracker syndrome, you will need to see a qualified urologist to make sure your pain isn't being caused by something else. To correctly diagnose loin pain hematuria syndrome or nutcracker syndrome, you will be asked to see our team, including urology, vascular surgery, interventional radiology, and transplant surgery.

Our team is multidisciplinary and has expertise in several different areas. This means you'll receive the correct diagnosis, and this information can help you decide ifrenal autotransplant is the best treatment.

Our multidisciplinary team includes:

  • urologists,
  • interventional radiologists,
  • cardiothoracic surgeons, and
  • transplant surgeons.

We have a similar multidisciplinary team at Primary Children's Hospital. Please contact us if your child is under 18 years old and you need RAT treatment. 

Testing

Some of the tests you may need will include:

  • labwork,
  • imaging (CT scans),
  • venograms, and
  • renal hilar block.

Find a Renal Autotransplant Team Member

Research

University of Utah Health's multidisciplinary group has multiple ongoing research projects to determine how kidney transplant can help treat kidney disease. We are also actively publishing the results of these studies.

You can read about some of our research activities here. We may invite you to participate.