The use of autologous saphenous vein grafts (ASVGs) is a rarely required means of facilitating implantation in certain renal transplant recipients,particularly in living donor recipients with short donor vessels or after donor vessel injury.A variety of methods have been described in literature to overcome this handicap including obtaining a cuff of IVC with the open approach, generous mobilization of recipient iliac vein by ligating the internal iliac vein. Lengthening of renal vein by use of synthetic graft, saphenous vein or gonadal vein remains an attractive option but experience in published literature remains limited.There is a paucity of data to guide management of this issue with the exception of reports of single cases. In this report, we outline a case of in a renal transplant recipient who was treated operatively via explantation, resection, and reconstruction ex situ with a living donor arterial allograft conduit transplant.

We report a case of living related renal transplantation that used the recipient's saphenous vein as a graft to extend the length of the right donor renal vein.

A saphenous vein autograft is a good natural material, but the difference in the diameter of the venous vessel relative to the renal vein causes technical difficulty . In literature there is a reported renal vein lengthening using the gonadal vein in cases of short allograft renal veins .They lengthened short allograft renal veins by spiral anastomosis of longitudinally cut gonadalveins. Spiral anastomosis was performed with the longitudinally cut gonadal vein fragment to form a tubular shape, enabling anastomosis with the allograft renal vein to achieve lengthening .We applied this method to the saphenous vein. The aforementioned method of revising the saphenous vein to match the allograft renal vein is useful for making a saphenous vein graft.Post transplantation,Immunosuppressive induction was achieved.Allograft kidney function was good after renal transplantation and follow-up duplex ultrasonography showed good blood flow in the transplanted renal artery and vein. The patient's serum creatinine level decreased from a preoperative value of 8.0 mg/dL to 2.1 mg/dL on postoperative day 1, and reached its nadir of 0.9 mg/dL on postoperative day 7. Protocol biopsy at 6 months showed no rejection and no ischemic change.Subsequent renal transplant surgery was successful and allograft renal function was good after transplantation.

When the longer axis of the renal graft vein is short, as in the right kidney, a saphenous vein graft may be useful.