Comparative Analysis External Iliac or Internal Iliac Arteries as Graft Selection for Renal Transplantation: A Scientific Inquiry

Abstract

Background: Renal transplantation is the definitive treatment for patients with end-stage renal disease (ESRD), offering improved quality of life and survival rates. The success of renal transplantation significantly depends on the surgical techniques employed, particularly the site of vascular anastomosis. While both external and internal iliac arteries are commonly used for this purpose, the impact of the choice between these two sites on transplant outcomes remains a subject of debate. Objective: This study aimed to compare the early post-operative outcomes of renal transplantation between anastomoses performed to the external iliac artery and those to the internal iliac artery, to determine if one technique offers superior results over the other. Methods: In a quasi-experimental study at the Institute of Kidney Diseases and Transplant, 50 patients with single-artery renal transplants, performed from January 2016 to July 2020, were divided into two groups based on the artery used for anastomosis: Group A (external iliac artery, n=25) and Group B (internal iliac artery, n=25). The study assessed various outcomes, including lymphocele formation, time to urine production, nadir serum creatinine levels, resistive index, hospital stay duration, and erectile function pre- and post-transplant, using the International Index of Erectile Function (IIEF) scoring system. Statistical analysis was conducted using IBM SPSS Statistics version 26. Results: The incidence of lymphocele formation was significantly higher in Group B (3 cases) compared to Group A (1 case) (P=0.045). No significant differences were found in the mean time to urine production (Group A: 22.5 minutes, Group B: 15.4 minutes), mean nadir serum creatinine (Group A: 1.17 mg/dl, Group B: 1.31 mg/dl), or mean resistive index (Group A: 0.62, Group B: 0.63). The mean hospital stay and changes in erectile function scores pre- and post-transplant were also similar between the groups. Conclusion: The choice between external and internal iliac artery anastomosis in renal transplantation does not significantly affect early post-operative outcomes, except for a higher risk of lymphocele formation with the internal iliac artery. These findings highlight the importance of surgical technique selection based on individual patient characteristics and suggest the need for further research to explore long-term outcomes.