Results of Renal Allograft in Recipient with Iliac Endarterectomy

Lee, Geun Woo; Cho, Won Hyun; Kim, Hyoung Tae; Park, Jun Mo; Park, Cheol Hee; Park, Sung Bae; Kim, Hyun Chul; Lee, Jin Hee; Woo, Seong Ku

Abstract

PURPOSE: Pretransplant peripheral vascular examination in renal transplant recipient is not common even though the uremic status is a risk factor of developing atherosclerosis. Since that kind of atherosclerotic stenosis is inadequate for renal artery anastomosis, surgeons should perform certain procedures in that area. Until now, we have no written report about the results of renal transplant recipient who have been done endarterectomy at anastomosing iliac artery. The aim of this paper is to review the results of renal allograft recepient whose anastomosed iliac artery is endarterectomized at the time of transplantation.
METHODS
Among 161 living donor renal allografts which were performed between January 1993 through June 1998, 21 allografts needed recipient iliac artery endarterectomy before vascular anastomosis. Their graft survivals, serial changes of blood pressure, serum creatinine level, and ultrasonic measure of renal arterial diameter and peak systolic velocity with their wave patterns were compared between endarterectomy group and non-endarterectomy group (control group). Mean age of endarterectomy group was older than control group (45.4 vs 32.9). Endarterectomy was done at internal iliac artery in 18 patients and both common and external iliac arteries in 3 patients.
RESULTS
One and 3 year graft survivals showed higher in endarterectomy group than control group (90.9% vs 82.3%). Uncontrolled hypertension of endarterectomy group was 6.3%, 11.5%, 27.3% in 12, 24, 36 months and that of control group was 18.9%, 23.6%, 25.1%, but there was no statistical significance between groups. Serial changes of serum creatinine level of endarterectomy group was maintained low until the end of 3 years compare to control group (1.2 0.9 mg/ml vs 1.9 1.1). There was no difference between groups in peak systolic velocity and wave pattern proximal and distal to the anastomotic site of renal artery, and also no difference in measured arterial diameter and resistance index.
CONCLUSION
Endarterectomy of recipient iliac artery before transplant renal vascular anastomosis show no adverse effect on recipient blood pressure, renal allograft function, graft survival and renal artery restenosis at least up to 3 years after graft.