2071 LONG TERM OUTCOMES OF THE INFERIOR EPIGASTRIC ARTERY IN THE REVASCULARIZATION OF LIVING DONOR KIDNEY TRANSPLANT WITH MULTIPLE ARTERIES

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery1 Apr 20112071 LONG TERM OUTCOMES OF THE INFERIOR EPIGASTRIC ARTERY IN THE REVASCULARIZATION OF LIVING DONOR KIDNEY TRANSPLANT WITH MULTIPLE ARTERIES Ioannis Antonopoulos, Affonso Piovesan, Renato Falci, Hideki Kanashiro, Fernando Saito, and William Nahas Ioannis AntonopoulosIoannis Antonopoulos Sao Paulo, Brazil More articles by this author , Affonso PiovesanAffonso Piovesan Sao Paulo, Brazil More articles by this author , Renato FalciRenato Falci Sao Paulo, Brazil More articles by this author , Hideki KanashiroHideki Kanashiro Sao Paulo, Brazil More articles by this author , Fernando SaitoFernando Saito Sao Paulo, Brazil More articles by this author , and William NahasWilliam Nahas Sao Paulo, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2344AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiple arteries (MA) occur in up to 23% of donated kidneys and their revascularization may be challenging. They should not be ligated when in the lower pole or supply significant areas of the renal parenchyma. Traditionally, a side to side anastomosis is preferred for reconstruction. A prospective protocol of revascularization of MA in transplants of living donors using the inferior epigastric artery (IEA) was established. Our objective is to compare the safety and long term outcomes of the IEA revascularization of small accessory kidney arteries (3mm or less) with the standard technique. METHODS The records of 602 consecutive living donor kidney transplants (March 2000 to September 2010) were reviewed. Age ranged 3-78 years (37.4±15). There were 451 (74.9%) white, 142 (23.6%) black and 9 (1.5%) asian patients. There were 324 (53.8%) male and 278 (46.2%) female. There were 440 (73.1%) transplants from related donors (RD) and 162 (26.9%) from unrelated donors (NRD). A total of 98 kidneys (16.3%) had MA. Of these, 83 (84.7%) had two and 15 (15.3%) had three arteries. In 21 (21.4%) kidneys with MA (GI), the (IEA) was used for vascular reconstruction. Four of them (14.3%) had 3 arteries and 17 patients (85.7%) had 2 arteries. The dissection of the (IEA) was made under loupes and an end-to-end anastomosis with the renal accessory artery was done. In the remaining 77 patients (GII), reconstruction was made with the standard technique. Follow-up ranged 1–124 months (43.8±38.1). Statistical analysis was made using the Fisher exact test and two tailed “t” test. RESULTS Delayed graft function occurred in 8 (38.1%) cases in GI and in 17 (22%) in GII, p>0.05. There was one partial renal infarction in each group (4.8% versus 1.3%, p>0.05). There was one urinary fistula in GI and 3 urinary fistulas plus one ureteral stenosis in GII (p>0.05). One graft (4.8%) lost function in GI and 5 (6.5%) in GII (p>0.05). Eleven (53.4%) patients were hypertensive in GI and 53 (68.8%) in GII, p>0.05. CONCLUSIONS The use of the inferior epigastric artery in the revascularization of living donor kidney transplant with multiple arteries is safe and effective yielding similar long term outcomes when compared to the standard technique. GI GII AGE 22-58 (40.5±12.3) 8-61 (35.6±14.8) male/fem.⁎ 16/5 37/40 white/black/asian 18/3/0 60/16/1 related/unrelat. donors 12/9 58/19 graft function (months) 1-124 (43.8±38.1) 2-128 (52.6±33.5) Glom. Filtr. (ml/min) 19.4-92.6 (52.9±17.7) 18.4-131.5 (62±21.2) ⁎ significant © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e829 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ioannis Antonopoulos Sao Paulo, Brazil More articles by this author Affonso Piovesan Sao Paulo, Brazil More articles by this author Renato Falci Sao Paulo, Brazil More articles by this author Hideki Kanashiro Sao Paulo, Brazil More articles by this author Fernando Saito Sao Paulo, Brazil More articles by this author William Nahas Sao Paulo, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...