Rationale/Objective: Anastomosis of multiple renal arteries (MRA) in living kidney donors is technically demanding. However, with the advent of better immunosuppression and improvement in surgical techniques, what used to be a relative contraindication is now used with increased frequency to meet the demands of our increasing list of patients needing renal transplantation. This study on prospective data was conducted to describe the different techniques for transplant of kidney grafts with multiple arteries and to determine the effect on graft function and patient survival when compared to kidney donor grafts with single artery.
Methods: Among the 521 kidney transplants that have been performed at the St. Luke's Medical Center from October 1988 to August 2005, sixty-seven adult patients with living donors having multiple arteries were analyzed. A matched population according to age and native kidney disease was chosen to serve as a control group composed of adult recipients with single artery allograft from a living donor. The graft recipients were divided into seven groups according to the technique used for vascular anastomosis.
Results: There was a significant increase in anastomosis time or rewarm ischemia time when multiple renal artery grafts were used (p=0.0055). Patient and graft status were followed-up at three, six and twelve months, and the renal status in terms of creatinine level and need for dialysis was determined. These were compared to the outcome of patients with single artery allograft. Analysis showed no significant difference (p = 0.06 at 3 months, 0.198 at 6 months & 0.384 at 1 year).
Conclusion: Patients may experience acute tubular necrosis initially due to the significantly longer anastomosis time but multiple renal artery grafts may be transplanted as successfully as those with single arteries. (Author)
This study aimed to illustrate the different surgical techniques for transplant of kidney grafts with multiple arteries and to determine the effect on graft function and patient survival.