2273 FATE OF THE ACCESSORY RENAL ARTERIES OF GRAFTS WITH MULTIPLE RENAL ARTERIES DURING LIVE-DONOR RENAL ALLO-TRANSPLANTATION

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery II1 Apr 20122273 FATE OF THE ACCESSORY RENAL ARTERIES OF GRAFTS WITH MULTIPLE RENAL ARTERIES DURING LIVE-DONOR RENAL ALLO-TRANSPLANTATION Ahmed Harraz, Ahmed Shokeir, Ibrahim Shalaby, Shady Soliman, Ahmed El-Hefnawy, Mohamed Kamal, Ahmed Kamal, and Mohamed Ghoneim Ahmed HarrazAhmed Harraz Mansoura, Egypt More articles by this author , Ahmed ShokeirAhmed Shokeir Mansoura, Egypt More articles by this author , Ibrahim ShalabyIbrahim Shalaby Mansoura, Egypt More articles by this author , Shady SolimanShady Soliman Mansoura, Egypt More articles by this author , Ahmed El-HefnawyAhmed El-Hefnawy Mansoura, Egypt More articles by this author , Mohamed KamalMohamed Kamal Mansoura, Egypt More articles by this author , Ahmed KamalAhmed Kamal Mansoura, Egypt More articles by this author , and Mohamed GhoneimMohamed Ghoneim Mansoura, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2451AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Donor grafts with multiple arteries are accepted alternative with equivalent outcome to grafts with single renal arteries. We aim at determining the effect of occlusion of the accessory artery on early graft function and delineating factors predicting occlusions of the accessory artery. METHODS A retrospective review of 731 consecutive live-related renal transplants was conducted between November 2002 and January 2011. A total of 105 consecutive grafts with multiple renal arteries were identified. The patency of the accessory artery was evaluated using Doppler US and MRA done at postoperative period. The frequency of patency was correlated with renographic clearance to delineate the effect on graft function. Factors predicting occlusion of the accessory artery were studied using univariate and multivariate analyses. RESULTS Doppler US diagnosed occlusion of the accessory arteries in 11 (10.5%) out of 105 grafts at a mean and median (range) of 8 and 9 (1-21) days post-transplantation, respectively. Mean ± SD and median (range) of renographic clearance of grafts with occluded accessory arteries were 50.5 ± 26 and 40 (21-92) ml/min while those of grafts with patent accessory arteries ware 68.6 ± 18.9 and 67.2 (21-117) (p<0.01). The percentage change of renographic clearance before and after transplantation has increased for grafts with patent arteries and decreased for grafts with occluded arteries (p=0.03). On multivariate analysis, factors predicting the occlusion of the accessory artery were delayed graft function (OR= 9.9, 95% CI= 1.6-58.6, p=0.01) and upper polar location of the accessory artery (OR=8.9, 95% CI= 1.8-43.4, p<0.01). On the other hand, the site of anastomosis (to major or inferior epigastric arteries) or anastomosing the artery to the main artery (bench surgery) had not affected the patency. Further analysis showed that the mean ± SD of the diameter of the upper polar arteries was 0.14 ± 0.09 cm and those of the hilar and lower polar arteries were 0.2 ± 0.06 and 0.2 ± 0.08, respectively (p=0.03). CONCLUSIONS Occlusion of the accessory renal artery has a negative impact on the early graft function. When considering grafts with accessory arteries, grafts with upper polar arteries should be paid the greatest attention and efforts should be exerted to avoid delayed graft function. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e917 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Harraz Mansoura, Egypt More articles by this author Ahmed Shokeir Mansoura, Egypt More articles by this author Ibrahim Shalaby Mansoura, Egypt More articles by this author Shady Soliman Mansoura, Egypt More articles by this author Ahmed El-Hefnawy Mansoura, Egypt More articles by this author Mohamed Kamal Mansoura, Egypt More articles by this author Ahmed Kamal Mansoura, Egypt More articles by this author Mohamed Ghoneim Mansoura, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...