René Küss: fifty years of retroperitoneal placement of renal transplants

doi:10.1016/S0041-1345(02)03626-6

Transplantation Proceedings

Volume 34, Issue 8, December 2002, Pages 3019-3025

https://doi.org/10.1016/S0041-1345(02)03626-6 Get rights and content

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Life of René Küss

René Küss was born in Paris, France, May 3, 1913, into a prominent family. His father, Georges Küss, was a surgeon at the Paris Hospital and was former President of the Academy of Surgery. Jeanne Amos, his mother, was from a famous family of brewers in the city of Metz in Lorraine. Well-educated in the arts, Küss attended Ecole Alsacienne, Paris, and Lycee Jeanson de Sailly, studying Latin, Greek, and philosophy.

Like his father, Küss embarked on a surgical career and entered the residency

Transplantation in the 1940s and 1950s

In 1948, surgeons in Paris, including Küss, Oudot, Vaysse, Oeconomos, and Rougeulle, performed experimental transplantations in dogs. They also worked on cadavers to determine the most suitable position for placing the transplanted kidney. Küss, impressed by good tolerance of ectopic pelvic kidneys, suggested that the iliac fossa and vessels were the appropriate location. As a urologist, Küss had been especially interested in end-stage renal disease (ESRD), which was responsible for a high

The Paris experience, 1960 and 1961

In 1960 and 1961 at Foch Hospital, Küss transplanted 6 patients who were treated initially with total body irradiation and later administered steroids and the new drug 6-mercaptopurine (6-MP) for immunosuppression. This regimen was initiated as a comprehensive approach to clinical transplantation at Foch Hospital, where Küss assembled a multidisciplinary team including Legrain (nephrologist), Mathé (immunologist), Tubiana (radiologist), Nedey (anesthesiologist), and surgeons Chatelain and Camey.

Later career

In 1971, Küss founded La Société Francaise de Transplantation, the first medical and scientific society devoted to transplantation immunology, medicine, and surgery in Europe. In 1976, a year in which he transplanted more than 75 patients, Küss described the findings of acute rejection on intravenous pyelography.²² He observed that in acute rejection there was a 3-dot image, which actually represented the 3 calyces that had shrunk due to papilla edema. Also due to to the decrease in urine

Coda

One of Küss’ patients has survived nearly 40 years posttransplantation; he is still driving 120 miles daily as an agricultural salesman without any problems. He is a living testimony to the success of transplantation and, at the same time, he illustrates the failure of medicine, which has been unable to prevent the deterioration and loss of such vital organs as the kidney. It is the hope of Küss¹¹ and many other transplantologists that the new century will bring about significant improvement in

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Cited by (13)

Altering the Approach: Open Minimally Invasive Renal Transplant in Obese Patients Through the Anterior Rectus Sheath
2017, Urology
To retrospectively analyze the wound issues for obese renal transplant patients, as well as post-transplant outcomes including graft and patient survival, hypothesizing improvement over the standard approach. As the obese population has expanded, minimally invasive renal transplant techniques have attempted to improve the issues of complications related to wounds and hernias. The anterior rectus sheath approach, which facilitates a minimal incision, has been adopted at our center for all renal transplants, including obese patients.
Between January 1, 2011 and December 31, 2014, 166 renal transplants were performed at the Charleston Area Medical Center with the new approach adopted in November 2012. Of the extraperitoneal transplants, 71 adult patients were classified as morbid/severe (≥35) or obese (30-34.9) by body mass index. Demographics, perioperative results, and outcomes were retrospectively collected for the conventional (CON) and anterior rectus sheath (ARS) approaches until August 21, 2015.
The ARS and CON groups comprised 40 of 71 (56%) and 31 of 71 (44%) patients, respectively. The majority of demographics and perioperative data indicated no significant statistical differences between procedures (P < .05). Wound complications, incision length, operative time, and glomerular filtration rate at 6 and 12 months were significantly different. Multivariate calculations indicated procedure as the only variable expected to affect wound healing in obese patients.
For obese patients, the ARS approach was shown to be an effective option that reduced wound complications and operative times. This easily adopted approach provides the obese and morbidly obese with comparable overall graft outcomes and significant improvement on wound complications.
First experience: Open small incision rectus sheath approach renal transplant: A case series
2017, International Journal of Surgery
Citation Excerpt :
Renal transplantation as the surgical intervention for end-stage renal disease continues to be more inclusive of higher risk patients, such as the obese, while aiming to minimize wound complications [1].
Prevention of wound complications is an important goal in surgery, and reduction of modifiable risks factors are an important step towards protecting patients from further complications. Renal transplantation has sought to be more inclusive giving access to transplantation to complex patient populations, many of which have an increased risk of complications specifically obese recipients. Surgical techniques continue to advance and may contribute to reducing complications. We hypothesized that the Anterior Rectus Sheath (ARS) Approach would provide an open transplant with minimal damage and less wound complications, including fluid collections such as lymphoceles, when compared to the conventional technique (CON) with equivalent graft function and survival.
The ARS approach was adopted at our center in November of 2012. Medical records for 44 patients that underwent kidney transplantation at our Center between May 1, 2012 and March 31, 2013 were reviewed with data collected up to August 2015. Two were excluded (2 intraperitoneal transplants), leaving 22 in the ARS group and 20 in the CON group.
Demographics, data, and perioperative factors were found to be similar, but operative and post-operative findings indicated significant differences between the groups. Significant reductions of wound complications, including fluid collections, were observed and operative time, incision length, and drain usage were improved with the ARS technique. Secondary outcome assessing overall patient outcomes showed no significant difference.
This retrospective review case series quantified that this easily adopted modification of the conventional transplant technique is a safe, effective, and swift approach to renal transplantation with favorable graft results and improved surgical outcomes with less post-operative wound complications.
René Küss (1913-2006)-A transplant pioneer in Paris
2013, Transplantation Proceedings
Citation Excerpt :
Besides many honours and titles, Küss was also president of the French College of Surgeons Meeting in 1980 and of the Académie Nationale de Médicine in 1987 and was awarded the European Association of Urology's Willy Gregoir Medal in 2002. Küss died on June 20, 2006.3 With the introduction of successful hemodialysis with an “artificial kidney” by the Dutch nephrologist Willem Kolff (1911–2009) in 1944, there was an increasing interest and new possibilities to treat acute and chronic renal insufficiency.
René Küss (1913–2006), an outstanding urologic surgeon, was one of the leading pioneers in kidney transplantation. He suggested and perfected the retroperitoneal placement of the donor kidney into the iliac fossa and its anastomosis to the iliac vessels in the early 1950s. He was one of the first to introduce an immunosuppressive regimen in kidney transplantation a decade later. Küss established the first multiple department of urology at the Paris hospitals, served as General Secretary and later as President for the Société Internationale d'Urologie from 1952 until 1985, and founded “La Société Francaise de Transplantation” as the first scientific society dedicated to transplantation medicine in Europe in 1971. Moreover, Küss was an art connoisseur and collector, an automobiliste, and a medical historian.
Laparoscopic kidney transplantation-novel or novelty?
2011, American Journal of Transplantation
Renal transplant assessment: Sonographic imaging
2010, Ultrasound Clinics
Citation Excerpt :
Basic understanding of the surgical technique and the anatomy of the possible vascular anastomoses is very useful for the sonographer in both performing and interpreting the ultrasound examination. Usually the transplant kidney is positioned within the retroperitoneum in the right iliac fossa, with an end-to-side anastomosis of the renal vasculature to the recipient’s external iliac artery and vein.9,10 The left iliac fossa is used if there is vascular disease in the right iliac vessels, in second transplants, and in the case of combined renal and pancreas transplants.
Sequential analysis of single-center experience of living donor kidney transplants with several vascular anastomosis techniques
2021, Turkish Journal of Medical Sciences

View all citing articles on Scopus

^☆: This work was supported in part by a grant from the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK 38016-15).

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Clinical transplantation proceedingsRené Küss: fifty years of retroperitoneal placement of renal transplants☆

Section snippets

Life of René Küss

Transplantation in the 1940s and 1950s

The Paris experience, 1960 and 1961

Later career

Coda

First page preview

Transplant Proc

J Urol

Wien Klin Wochenschr

Lyon Med

Surg Gynecol Obstet

Silo ed

JAMA

Bull Soc Med Hop Paris

Mem Acad Chir

Clinical transplantation proceedings
René Küss: fifty years of retroperitoneal placement of renal transplants☆