Clinical Outcome of Microsurgical Multiple Renal Artery Reconstruction in Renal Transplantation

Choi, Sang Seok; Kim, Song Cheol; Han, Duck Jong

Abstract

The incidence of multiple renal arteries has been reported as 18~30% in cadaveric organ procurement. There has been many cases in which the reconstruction of renal arteries were needed because of the use of donor kidney with multiple renal arteries or the injuries of renal arteries during organ harvest. We studied on the graft function and survival following reconstruction of multiple renal arteries. Between January 1990 and December 1996, we have performed 500 renal transplants, among which 65 cases(13%) of the multiple donor renal arteries were encountered either from the multiple number of donor renal artery itself or from the injury of renal artery during harvest. The remaining 435 cases had a single donor renal artery. The type of reconstruction under the microscope and graft material that we have used were illustrated as follows; ligation of a polar artery or two polar arteries in 8 cases, end to side anastomosis between a polar artery and main renal artery in 26 cases, side to side anastomosis between a polar artery and main renal artery in 12 cases, separate anastomosis of two renal arteries to external iliac or internal iliac artery in 2 cases, side to side anastomosis between two polar arteries then end to side anastomosis between reconstructed polar artery and a main renal artery in 3 cases, Carrel aortic patch in 3 cases, and interposition graft in 10 cases using inferior epigastric artery in 6 cases, branched internal iliac artery in 3 cases, and saphenous vein in 1 case. In the kidneys with reconstructed multiple renal arteries, the rate of vascular and urologic complications such as bleeding, stenosis, thrombosis of anastomotic site, ureteral obstruction and urinary leakage did not show any difference with the single renal artery group. And there was no difference in 1-year graft survival between the two groups. We think that the donor kidney with reconstructed multiple renal arteries does not have any negative impact on graft survival resulting in same early and late vascular and urologic complications as a single renal artery group when proper revascularization can be performed.