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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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Holbert BL, Aziz JM, Harriman DI, Gurram VR, Gurung KB, Farney AC, Jay CC, Rogers J, Stratta RJ, Orlando G. A Renal Allograft With 6 Arteries Can Be Successfully Transplanted. EXP CLIN TRANSPLANT 2021; 19:994-997. [PMID: 33641660 DOI: 10.6002/ect.2020.0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Brenda L Holbert
- From the Department of Radiology, Wake Forest Baptist Medical Center, North Carolina, USA
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Vincenzi P, Gonzalez J, Guerra G, Gaynor JJ, Alvarez A, Ciancio G. Complex Surgical Reconstruction of Upper Pole Artery in Living-Donor Kidney Transplantation. Ann Transplant 2021; 26:e926850. [PMID: 33446626 PMCID: PMC7814512 DOI: 10.12659/aot.926850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The use of allografts with multiple renal arteries has increased in the era of laparoscopic donor nephrectomy. Although several studies recommend reconstructing lower pole arteries (LPAs) to reduce risk of urologic complications, it is common opinion to ligate upper pole arteries (UPAs) with a diameter less than 2 mm because of increased risk of thrombosis related to their reconstruction. This retrospective study evaluates the feasibility and safety of reconstructing thin UPAs during living-donor kidney transplantation, with the goal of maintaining the integrity of the graft and assuring its maximal function. Material/Methods Data from 922 living-donor kidney transplants performed between 2009 and 2019 were reviewed. Six cases with UPAs were identified (0.65%). The study endpoints were incidence of allograft vascular and urologic complications, slow graft function, delayed graft function, graft failure, and graft and patient survival. Results The UPAs had a mean diameter of 1.8±0.28 mm. Methods of reconstruction included: interposition graft (n=2), end-to-side anastomosis inside the renal hilum to a branch of the main renal artery (n=3), and side-to-side anastomosis with the main renal artery (n=1). Additional reconstruction of LPAs (n=2) and main renal arteries (n=2) was performed. During a median (range) follow-up of 14.5 (9–49) months no complications were observed. Conclusions Ex vivo reconstruction of UPAs with a diameter less than 2 mm is worth attempting, particularly in the setting of living-donor kidney transplantation.
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Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Javier Gonzalez
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giselle Guerra
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Department of Medicine, Division of Nephrology, Miami Transplant Institute, Miami, FL, USA
| | - Jeffrey J Gaynor
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Angel Alvarez
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Department of Urology, Miami Transplant Institute, Miami, FL, USA
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Li Y, Song Y, Hu W, Wang X, Xiao Y, Huang C. Methylene blue usage for determining accessory artery ligation in donor kidneys. Surg Innov 2020; 28:458-464. [PMID: 33124503 DOI: 10.1177/1553350620971474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. We present a technique for determining whether to ligate or preserve accessory arteries in donor kidneys before implantation. Methods. Forty-three living-related donor kidneys in patients from January 2014 to February 2018 at our institution were included, all of which had dual arteries without the same stem. Among them, 19 cases of accessory arterial blood supply were evaluated using methylene blue (MB) perfusion, and accessory arteries supplying less than 10% of the total MB perfusion volume were ligated. The other 24 cases were assessed using a conventional method in which arteries with diameters less than 2 mm were ligated. The back-table surgical time, Doppler ultrasonography index, renal function and complications were compared between the 2 groups. Results. All patients underwent successful kidney transplantation. The back-table surgical time in the MB group was longer than that in the conventional group (42.70 ± 4.70 min vs 34.64 ± 5.30 min, P < .05). The serum creatinine level in the MB group was significantly lower than that in the conventional group 1 month after the operation (103.15 ± 19.26 μmol/L vs 119.17 ± 28.32 μmol/L, P < .05). No differences in the Doppler ultrasonography index or postoperative complications were noted. Conclusions. MB perfusion provides an easy and effective method to make decisions regarding arterial ligation and helps preserve renal function without increasing the number of complications after transplantation.
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Affiliation(s)
- Yang Li
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Yajun Song
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Wengang Hu
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Xu Wang
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Ya Xiao
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Chibing Huang
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
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