How Can We Increase Living Related Donor Renal Transplantations?

A Novel Assessment of Vascular Regions Using an Intraoperative Near-Infrared Fluorescence

INTRODUCTION

The risk of complications and transplant renal function increases in multiple arterial renal transplantations compared with single arterial renal transplantations. Even when multiple arteries are involved, with the introduction of laparoscopic nephrectomy, I mainly choose the left side kidney. Therefore, the number of renal artery reconstructions is increasing, and simultaneous imaging of arterial rebuilding during the donor nephrectomy is important.

MATERIAL

Between 2006 and 2015, we performed 132 living donor kidney transplantations at our center and analyzed 32 cases that were diagnosed pre- and intraoperatively.

METHOD

We compared the single renal artery (SRA) and multiple renal arteries (MRA) groups and analyzed the number of renal arteries, reconstruction methods, donor and recipient ages, sex, total ischemic times, and 1-month serum creatinine values.

RESULT

In the MRA and SRA groups, the average recipient age was 52.3 and 47.0 years, respectively, while the average donor age was 52.9 and 53.1 years, respectively. In SRA and MRA groups, total ischemic time (TIT) was 96.1 and 143.6 min (P < .01). Serum creatinine level 1 month post-transplantation was 1.54 and 1.25, respectively (P < .001). Here we experienced 12 cases of living renal donor nephrectomy with multiple vessels in which the vascular supply territory was first assessed in April 2013 using an intraoperative near-infrared fluorescence camera system. In addition, regarding TIT, it is possible to shorten surgery by using individual anastomosis and ligation.

CONCLUSION

By managing multiple donors; arteries by nephrectomy, it is possible to improve kidney transplantation results.

Role of multidetector-row computed tomography in evaluation of living renal donors

OBJECTIVES

To assess the value of multidetector-row computed tomography (MDCT) in evaluation of the anatomy of living kidney donors and to reveal the prevalence of renal vascular variations in a Chinese population.

PATIENTS AND METHODS

One hundred four potential donors underwent MDCT, and the data sets were postprocessed for reformatted images using maximum intensity projection, a volume-rendering technique, and multiplanar re-formation. Nephrectomy was performed in 97 donors, which enabled correlation of MDCT evaluation with the actual anatomy at surgery as the standard of reference.

RESULTS

The MDCT images accurately demonstrated the anatomical structure of the main renal arteries and veins and the upper part of the ureters. The prevalence of accessory arteries was 41.7% (43 of 103), and of early branching was 12.6% (13 of 103). Compared with findings during surgery, the detection rate of accessory arteries on MDCT images was 91.3% (21 of 23), of larger accessory arteries (>1.5 mm in diameter) was 100%, and of early branching was 100%.

CONCLUSION

Multidetector-row computed tomography is helpful in accurately evaluating the renal anatomy of potential donors, thus facilitating planning of surgery.