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Schmidt J, Peters R, Mang J, Ralla B, Moldovan DE, Dagnæs-Hansen J, Liefeldt L, Budde K, Lerchbaumer M, Friedersdorff F. Retrospective analysis of the perioperative outcome in living donor kidney transplantation with multiple renal arteries: does accessory vessel ligation affect the outcome? World J Urol 2024; 42:161. [PMID: 38488940 PMCID: PMC10942927 DOI: 10.1007/s00345-024-04883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE Accurate surgical reconstruction of arterial vascular supply is a crucial part of living kidney transplantation (LDKT). The presence of multiple renal arteries (MRA) in grafts can be challenging. In the present study, we investigated the impact of ligation versus anastomosis of small accessory graft arteries on the perioperative outcome. METHODS Clinical and radiological outcomes of 51 patients with MRA out of a total of 308 patients who underwent LDKT with MRA between 2011 and 2020 were stratified in two groups and analyzed. In group 1 (20 patients), ligation of accessory arteries (ARAs) and group 2 (31 patients) anastomosis of ARAs was performed. RESULTS Significant differences were observed in the anastomosis-, surgery-, and warm ischemia time (WIT) in favor of group 1. Students t-test showed comparable serum creatinine levels of 2.33 (± 1.75) to 1.68 (± 0.83) mg/dL in group 1 and 2.63 (± 2.47) to 1.50 (± 0.41) mg/dL in group 2, were seen from 1 week to 1 year after transplant. No increased rates of Delayed graft function (DGF), primary transplant dysfunction and transplant rejection were seen, but graft loss and revision rates were slightly higher when the ARAs were ligated. Analysis of Doppler sonography revealed that segmental perfusion deficits tend to regenerate during the clinical course. CONCLUSION Ligation of smaller accessory renal arteries may not affect the outcome of living kidney transplantation, except for a minor increase in the reoperation rate. Segmental perfusion deficits of the graft seem to regenerate in most cases as seen in Doppler sonography.
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Affiliation(s)
- Jacob Schmidt
- Department of Urology, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Peters
- Department of Urology, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Josef Mang
- Department of Urology, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernhard Ralla
- Department of Urology, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Diana Elena Moldovan
- Department of Urology, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Lutz Liefeldt
- Department of Nephrology and Intensive Care, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Intensive Care, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Markus Lerchbaumer
- Department of Radiology, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
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Kundaktepe BP, Durgun AV, Göksoy E, Pekmezci S, Kapan M, Sarıbeyoğlu K, Velidedeoğlu M, Eliçevik M. Sequential analysis of single-center experience of living donor kidney transplants with several vascular anastomosis techniques. Turk J Med Sci 2021; 51:1439-1447. [PMID: 33610142 PMCID: PMC8283428 DOI: 10.3906/sag-2007-285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/20/2021] [Indexed: 11/03/2022] Open
Abstract
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 Uni- versity 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 end- to-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.
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Affiliation(s)
- Berrin Papila Kundaktepe
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ali Vedat Durgun
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ertuğrul Göksoy
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Salih Pekmezci
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Metin Kapan
- Department of General Surgery, Faculty of Medicine, İstinye University Liv Hospital, İstanbul, Turkey
| | - Kaya Sarıbeyoğlu
- Department of General Surgery, Carl Thiem Klinikum, Cottbus, Germany
| | - Mehmet Velidedeoğlu
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Mehmet Eliçevik
- Department of Pediatric Surgery, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
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