Abstract
Introduction: The presence of multiple renal arteries (MRA) in the donor allograft was once a contraindication to transplantation. Despite concerns about risks, these allografts are being increasingly used to overcome a shortage of renal donors. Objectives: To compare the outcomes of live-donor renal allografts with multiple and single renal arteries (SRA) in terms of overall ischemia times, early and late graft function, and vascular and urological complications. Methods: A prospective, non-randomized cohort study was conducted including all live donor renal transplants done by the Vascular and Transplant Unit of the National Institute of Nephrology Dialysis and Transplantation, Sri Lanka between March 2010 and March 2016. 312 recipients of live donor renal allografts were recruited to the study. Patients were divided into three groups: Group 1—SRA: single anastomosis (n = 264, 85%); Group 2—MRA: single conjoined anastomosis (n = 39, 12%); and Group 3—MRA: ≥2 anastomoses (n = 9, 3%). Results: Mean ischaemia times (donor clamping to graft reperfusion) in the three groups were 14, 21 and 17 minutes respectively. Failure to normalize creatinine within 72 hours was seen in 29/264 (11%), 4/39 (10.2%) and 1/9 (11%), (P >0.05). Delayed graft function (attributable to severe rejection) occurred in only one patient who was from group 2. One-year graft survival among the groups was 243/264 (92%), 35/39 (90%) and 8/9 (89%), (P > 0.05). One patient from groups 1 and 2 developed transplant renal artery stenosis. Two patients from group 1 needed stenting for ureteric stenosis. Conclusions: Donor grafts with MRA may be accepted safely with careful surgical reconstruction and close surveillance post-transplant.
Highlights
The presence of multiple renal arteries (MRA) in the donor allograft was once a contraindication to transplantation
A prospective, non-randomized cohort study was conducted including all live donor renal transplants done by the Vascular and Transplant Unit of the National Institute of Nephrology Dialysis and Transplantation, Sri Lanka between March 2010 and March 2016. 312 recipients of live donor renal allografts were recruited to the study
Patients were divided into three groups: Group 1—single renal arteries (SRA): single anastomosis (n = 264, 85%); Group 2—MRA: single conjoined anastomosis (n = 39, 12%); and Group 3—MRA: ≥2 anastomoses (n = 9, 3%)
Summary
The presence of multiple renal arteries (MRA) in the donor allograft was once a contraindication to transplantation. The presence of multiple renal arteries (MRA) in prospective renal donors was once considered a relative contraindication to live donor renal transplantation (LDRT). This presumed technical difficulty in anastomosis and potential for increased vascular and secondary urological complications resulted in many potential healthy donors being overlooked for more favourable renal anatomy in deceased donors or alternate live donors [1]. With increasing expertise in vascular reconstruction and surgical technique, the acceptance rate of donors with MRA has increased universally among transplant centers The impact of such complex donor arterial anatomy on the graft function and overall outcome remains an area of interest with limited available data
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