Multiple renal arteries in patients with kidney transplantation: Initial experiences of the new kidney transplant center

Amaç: Birden fazla renal arter anastomozu yap ılan böbrek nakilli hastalarda gelişen komplikasyonlar ve uzun dönem nakil böbrek fonksiyon sonuçlarını de ğerlendirmek. Gereç ve Yöntem: 2010 ile 2014 yılları arasında yap ılan 115 böbrek nakil hastasının verilerini geriye dönük olarak inceledik. Toplamda 115 donör nefrektomi ameliyatı gerçekle ştirildi. Bunlardan 99 tanesinde transplante edilen böbrekte tek ve 16 tanesinde (yaklaş ık %16) ise birden fazla renal arter vard ı. Bu 16 hastadan 5 tanesine kadavra ve 11 tanesinide canlı donörden böbrek nakli yapıld ı. Bulgular: Çalış maya dahil edilen hastaların ortalama yaşı 38,5 (9-58 ya ş arası) ve ortalama takip süreleride 22,5 ay ( en az 3,5 ay ve en fazla 41 ay) idi. Kadavradan yapılan nakillerde ortalama so ğ uk iskemi süresi 1396 dakika iken canlı vericili böbrek nakillerinde bu süre 153 dakika olarak ölçüldü. Aynı zamnda canlı vericili böbrek nakillerinde s ıcak iskemi süreside 236 saniye olarak ölçüldü. Vakaların tümünde reperfüzyonu takiben böbrek fonksiyonları hemen başlad ı. 14 vakada erken dönemde böbrek fonksiyonlarından herhangi birinde bozukluk olmad ı. Sonuç:   Böbrek naklinde birden çok arter anastomozu baz ı riskler taşır. Uzamış sıcak ve so ğ uk iskemi sürelerine ba ğlı sıklıkla greft fonksiyon kaybı ve rejeksiyonu gözlenebilir. Backtable iş lemi sırasında yapılan iyi bir haz ırlık ile iskemi süresi artmadan greft fonksiyonları korunarak multiple arterli hastalarda güvenle böbrek nakli yap ılması daha uygun olacaktır.

Böbrek naklinde çoklu arter: Yeni bir böbrek transplant merkezinin başlangıç deneyimi

Objective: Multiple renal artery grafts of kidney transplant patients developing complications and results for long-term kidney function were evaluated. Material and Method: From 2010 to 2014, 115 kidney transplant patients were evaluated retrospectively. A sum of, 115 donor nephrectomies were performed in our instution. Kidney were transplanted with a single artery to 99 patients and sixteen (approximate 14%) with more than one. For five of these 16 patients, the organs were transplanted from a cadaver and eleven were transplanted from living donors. Results: Mean age was 38,5 years (range 9–58 years), mean follow up time was 22,5 month (min. 3,5 and max. 41 month) and mean cold ischemia time was 153 minutes for living donor transplantations and 1396 minutes for cadaveric transplantation, and also warm ischemia time was 236 seconds for living donor transplantation. In all cases, the grafted kidney began to function immediately after reperfusion. Fourteen of the recipients had no any early kidney dysfunction, a problem that is usually attributed to prolonged anastomosis time. Conclusion: Transplanting kidneys with multiple renal arteries may result in significant risks. Prolonged cold or hot ischemia time may elevate incidence of non functional graft and rejection. Results of this study points that unifying artery anastomosis at the backtable would reduce the risk.

Kaynakça

1. Abbaszadeh S, Hossein Nourbala M, Alghasi M, Sharafi M, Einollahi B. does renal artery multiplicity have ımpact on patient and allograft survival rates? Nephro-Urol Mon 2009; 1: 45-50.

2. Kumar A, Gupta RS, Srivastava A, Bansal P. Sequential anastomosis of accessory renal artery to inferior epigastric artery in the management of multiple arteries in live related renal transplantation: a critical appraisal. Clin Transplant 2001; 15: 131-5

3. Khan TT, Koshaji B, Kamal S, Akhtar F, Rahman E. Multiple renal arteries in living donor kidney transplantation: Limits of recipient warm ischemia. Saudi J Kidney Dis Transpl 2014: 25, 651.

4. Delmonico F. Council of the transplantation society: a report of the amsterdam forum on the care of the live kidney donor: data and medical guidelines. Transpl 2005; 53: 79.

5. Miura M, Seki T, Harada H, et al. Clinical evaluation of donor renal artery reconstruction in kidney transplantation. Transplant Proc 1996; 28: 1611-15.

6. Oesterwitz H, Scholz D, Kaden J, Mebel M. Prolongation of rat renal allograft survival time by donor pretreatment with 8- methoxypsoralen and longwave ultraviolet irradiation of the graft (PUVA therapy). Urological research 1985; 13: 95-8.

7. Roza AM, Perloff LJ, Naji A, Grossman RA, Barker CF. Living-related donors with bilateral multiple renal arteries. A twenty-year experience. Transpl 1989; 47: 397-9.

8. Guerra EE, Didone EC, Zanotelli ML, Vitola SP, Cantisani GP, Goldani JC, Garcia VD. Renal transplants with multiple arteries. In Transplantation proceedings 1992; 24-5: 1868.

9. Benedetti E, Troppmann C, Gillingham K, Sutherland DE, Payne WD, Dunn DL, Grussner RW. Short-and long-term outcomes of kidney transplants with multiple renal arteries. Annals Surgery 1995; 221: 406.

10. Hashimoto Y, Nagano S, Ohsima S, et al. Surgical complications in kidney transplantation: experience from 1200 transplants performed over 20 years at six hospitals in central Japan. Transplant Proc 1996; 28: 1465-7.

11. Kocak T, Nane I, Ander H, Ziylan O, Oktar T, Ozsoy C. Urological and surgical complications in 362 consecutive living related donor kidney transplantations. Urol Int 2004; 72: 252-6.

Kaynak Göster