Abstract

Aim: Complex arterial reconstruction in kidney transplantation (KT) using kidneys from deceased donors (DD) warrants additional study since little is known about the effects on the mid- and long-term outcome and graft survival. Methods: A total of 451 patients receiving deceased donor KT in our department between 1993 and 2017 were included in our study. Patients were divided into three groups according to the number of arteries and anastomosis: (A) 1 renal artery, 1 arterial anastomosis (N = 369); (B) >1 renal artery, 1 arterial anastomosis (N = 47); and (C) >1 renal artery, >1 arterial anastomosis (N = 35). Furthermore, the influence of localization of the arterial anastomosis (common iliac artery (CIA), versus non-CIA) was analyzed. Clinicopathological characteristics, outcome, and graft and patient survival of all groups were compared retrospectively. Results: With growing vascular complexity, the time of warm ischemia increased significantly (groups A, B, and C: 40 ± 19 min, 45 ± 19 min, and 50 ± 17 min, respectively; p = 0.006). Furthermore, the duration of operation was prolonged, although this did not reach significance (groups A, B, and C: 175 ± 98 min, 180 ± 35 min, and 210 ± 43 min, respectively; p = 0.352). There were no significant differences regarding surgical complications, post-transplant kidney function (delayed graft function, initial non-function, episodes of acute rejection), or long-term graft survival. Regarding the localization of the arterial anastomosis, non-CIA was an independent prognostic factor for deep vein thrombosis in multivariate analysis (CIA versus non-CIA: OR 11.551; 95% CI, 1.218–109.554; p = 0.033). Conclusion: Multiple-donor renal arteries should not be considered a contraindication to deceased KT, as morbidity rates and long-term outcomes seem to be comparable with grafts with single arteries and less complex anastomoses.

Highlights

  • Kidney transplantation (KT) is the treatment of choice in patients with end-stage renal disease and it improves patient survival and recipients’ quality of life compared to chronic dialysis treatment [1,2,3].During kidney graft implantation, vascular anastomosis is one of the most challenging aspects for the transplant surgeon, and post-operative vascular complications such as bleeding or thrombosis can require surgical repair or even nephrectomy [4]

  • Living kidney transplantation (KT) were excluded from the study, as deceased donor organs cannot be compared with living donor organs regarding graft outcome and survival rates

  • Warm ischemia time significantly increased with the complexity of arterial reconstruction

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Summary

Introduction

Kidney transplantation (KT) is the treatment of choice in patients with end-stage renal disease and it improves patient survival and recipients’ quality of life compared to chronic dialysis treatment [1,2,3].During kidney graft implantation, vascular anastomosis is one of the most challenging aspects for the transplant surgeon, and post-operative vascular complications such as bleeding or thrombosis can require surgical repair or even nephrectomy [4]. Complex arterial reconstructions are often necessary, as kidney grafts carry two or more arteries in about 30% of cases [5]. Only a few publications have addressed the issue of multiple renal arteries and complex vascular reconstructions in KT using kidneys from deceased donors (DD). Most of them investigated KT after living donation (LD) or study groups including both LD and DD KT [6]. This could induce bias, as LD offers better pre-operative planning and pre-selection, as well as better graft outcome and survival rates than DD kidney grafts [1,7]

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