The Application of the Iliac Artery in the Ex Vivo Reconstruction of Renal Arteries in Renal Transplantation

Abstract

OBJECTIVE.: Renal transplantation is generally accepted as one of the most effective treatment options for the end-stage renal disease. However, donor kidneys with multiple renal arteries represent a surgical challenge. For these cases, the surgical strategy is to directly anastomose multiple renal arteries to the internal iliac artery or the external iliac artery. However, this approach is complicated by the difficulty in performing the anastomoses, bleeding, stenosis, and a high incidence of false aneurysms. METHODS.: By applying the method of ex vivo reconstruction of the donor renal artery with the recipient internal iliac artery, we repaired five cases of donor kidneys with more than three renal arteries and excessively short renal arteries during transplantation and treated three cases of renal aneurysms with renal autotransplantation. RESULTS.: In all the cases, the surgery was without complications. At a minimum follow-up of 4 years, all patients showed normal renal function, and color Doppler ultrasonography indicated no thrombus or aneurysm formation or obstruction in the renal artery or its branches. CONCLUSIONS.: The ex vivo reconstruction of the donor renal artery with the recipient internal iliac artery is a feasible and effective surgical procedure for the transplantation of donor kidneys with multiple renal arteries and the autotransplantation of kidneys for the treatment of renal artery aneurysms.