Mehmet VELİDEDEOĞLU, Kaya SARIBEYOĞLU, Salih PEKMEZCİ, Mehmet ELİÇEVİK, Metin KAPAN, Berrin Papila KUNDAKTEPE, Ali Vedat DURGUN, Ertuğrul GÖKSOY

Sequential analysis of single-center experience of living donor kidney transplants with several vascular anastomosis techniques

Background and aim: Vascular variations of grafts are handled with various reconstruction techniques in renal transplantation. We aimed to analyze the effects of these reconstruction techniques and sites on patient/graft outcomes. Materials and methods: Renal transplantation cases at the Transplantation Unit of the General Surgery Department, İstanbul University Cerrahpaşa Medical Faculty between January 1st, 2000 and December 31st, 2012 were analyzed retrospectively. Postoperative duplex ultrasound results, urea-creatinine reduction rates, and complications were evaluated. Results: There were 228 living-donor transplantation cases evaluated. For single-renal-artery living-donor transplantations, there were 45 end-to-side external iliac artery, 15 end-to-side internal iliac artery, 152 end-to-end internal iliac artery, and 3 end-to-side common iliac artery anastomoses performed. In cases with double-arteries, 3 had end-to-side external iliac artery anastomoses, and 10 had endto-end internal iliac artery anastomoses. No statistically significant differences were found between reconstruction techniques with regard to complications or urea-creatinine reduction rates. Conclusion: Internal, external, and common iliac arteries can be safely used for anastomoses. The presence of more than one renal artery creates no short or long-term problems when a side-to-side anastomosis is initially performed.Key words: Renal transplantation, graft vascular variation, anastomosis, complication

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1. Goodman J, Gaston RS. Patient selection and indications for kidney transplantation. In: Kirk AD, Knechtle SJ, Larsen CP, Madsen JC, Pearson TC et al (editors). Textbook of Organ Transplantation. West Sussex, UK: John Wiley & Sons, Ltd; 2014. pp. 351-363. doi:10.1002/9781118873434
2. Matheus WE, Reis LO, Ferreira U, Mazzali M, Denardi F et al. Kidney transplant anastomosis: internal or external iliac artery? Urology Journal 2009; 6 (4): 260-266.
3. Cinqualbre J, Kahan BD, Kuss R. Fifty years of retroperitoneal placement of renal transplants. Transplantation Proceedings 2002; 34 (8): 3019-3025. doi: 10.1016/s0041-1345(02)03626-6
4. Keller JE, Dolce CJ, Griffin D, Heniford BT, Kercher KW. Maximizing the donor pool: use of right kidneys and kidneys with multiple arteries for live donor transplantation. Surgical Endoscopy 2009; 23 (10): 2327-2331. doi: 10.1007/s00464-009- 0330-9
5. Kadotani Y, Okamoto M, Akioka K, Ushigome H, Ogino S et al. Management and outcome of living kidney grafts with multiple arteries. Surgery Today 2005; 35 (6): 459-466. doi: 10.1007/ s00595-004-2967-2
6. Sutherland RS, Spees EK, Jones JW, Fink DW. Renal artery stenosis after renal transplantation: the impact of the hypogastric artery anastomosis. The Journal of Urology 1993; 149: 980-985. doi: 10.1016/s0022-5347(17)36273-0
7. Orlic P, Vukas D, Drescik I, Ivancic A, Blecic G et al. Vascular complications after 725 kidney transplantations during 3 decades. Transplantation Proceedings 2003; 35 (4): 1381-1384. doi: 10.1016/s0041-1345(03)00506-2
8. Soy EHA, Akdur A, Kirnap M, Boyvat F, Moray G et al. Vascular complications after renal transplant: a single-center experience. Experimental and Clinical Transplantation 2017; 15 (Suppl 1): 79-83. doi: 10.6002/ect.mesot2016.O65
9. Breda A (Chair), Budde K, Figueiredo A, García EL, Olsburgh J (Vice-chair) et al. European Association of Urology Guidelines on Renal Transplantation. In: EAU Annual Congress; Amsterdam, The Netherlands. pp. 13-17.
10. Mohamed IH, Bagul A, Doughman T, Nicholson ML. Use of internal iliac artery as a side-to-end anastomosis in renal transplantation. Annals of the Royal College of Surgeons of England 2012; 94 (1): e36–e37. doi: 10.1308/003588412X1317 1221499540
11. Pal DK, Sanki PK, Roy S. Analysis of outcome of end-to-end and end-to-side internal iliac artery anastomosis in renal transplantation: Our initial experience with a case series. Urology Annals 2017; 9 (2): 166-169. doi: 10.4103/0974- 7796.204176
12. Benedetti E, Troppmann C, Gillingham K, Sutherland DE, Payne WD et al. Short- and long-term outcomes of kidney transplants with multiple renal arteries. Annals of Surgery 1995; 221 (4): 406-414. doi: 10.1097/00000658-199504000- 00012
13. Wolters HH, Schult M, Heidenreich S, Chariat M, Senninger N et al. The anastomosis between renal polar arteries and arteria epigastrica inferior in kidney transplantation: an option to decrease the risk of ureter necrosis? Transplant International 2001; 14 (6): 442-444. doi: 10.1007/s001470100011
14. Tyson MD, Castle EP, Ko EY, Andrews PE, Heilman RL et al. Living donor kidney transplantation with multiple renal arteries in the laparoscopic era. Urology 2011; 77 (5): 1116- 1121. doi: 10.1016/j.urology.2010.07.503
15. Kok NF, Dols LF, Hunink MG, Alwayn IP, Tran KT et al. Complex vascular anatomy in live kidney donation: imaging and consequences for clinical outcome. Transplantation 2008; 85 (12): 1760-1765. doi: 10.1097/TP.0b013e318172802d
16. Vázquez R, Garcia L, Morales-Buenrostro L, Gabilondo B, Alberú J et al. Renal grafts with multiple arteries: a relative contraindication for a renal transplant? Transplantation Proceedings 2010; 42 (6): 2369-2371. doi: 10.1016/j. transproceed.2010.05.003
17. Gawish AE, Donia F, Samhan M, Halim MA, Al-Mousawi M. Outcome of renal allografts with multiple arteries. Transplantation Proceedings 2007; 39 (4): 1116-1117. doi: 10.1016/j.transproceed.2007.03.067
18. Ghazanfar A, Tavakoli A, Zaki MR, Pararajasingam R, Campbell T et al. The outcomes of living donor renal transplants with multiple renal arteries: a large cohort study with a mean followup period of 10 years. Transplantation Proceedings 2010; 42 (5): 1654-1658. doi: 10.1016/j.transproceed.2009.12.067
19. Vaccarisi S, Bonaiuto E, Spadafora N, Garrini A, Crocco V et al. Complications and graft survival in kidney transplants with vascular variants: our experience and literature review. Transplantation Proceedings 2013; 45 (7): 2663-2665. doi: 10.1016/j.transproceed.2013.07.007
20. Vaccarisi S, Barcellona E, Cannistrà M, Canonaco M, Rizzuti S et al. Kidney transplantation at Annunziata Hospital of Cosenza: report of 10 years experience. Transplantation Proceedings 2009; 41 (4): 1168-1169. doi: 10.1016/j. transproceed.2009.02.055
21. Hwang JK, Kim SD, Park SC, Choi BS, Kim JI et al. The longterm outcomes of transplantation of kidneys with multiple renal arteries. Transplantation Proceedings 2010; 42 (10): 4053-4057. doi: 10.1016/j.transproceed.2010.09.075