TITLE:
Multiple Renal Arteries in Live Donor Renal Transplantation; Impact on Graft Function and Outcome: A Prospective Cohort Study
AUTHORS:
Dilushi Rowena Wijayaratne, Dinesha Himali Sudusinghe, Nalaka Gunawansa
KEYWORDS:
Multiple Renal Arteries, Live Donor Renal Transplant
JOURNAL NAME:
Open Journal of Organ Transplant Surgery,
Vol.8 No.1,
January
18,
2018
ABSTRACT: Introduction: The
presence of multiple renal arteries (MRA) in the donor allograft was once a
contraindication to transplantation. Despite concerns about risks, these
allografts are being increasingly used to overcome a shortage of renal donors. Objectives: To compare the outcomes of live-donor renal allografts with multiple and
single renal arteries (SRA)
in terms of overall ischemia times, early and late graft function, and vascular
and urological complications. Methods: A prospective, non-randomized
cohort study was conducted including all live donor renal transplants done by
the Vascular and Transplant Unit of the National Institute of Nephrology
Dialysis and Transplantation, Sri Lanka between March 2010 and March 2016. 312
recipients of live donor renal allografts were recruited to the study. Patients
were divided into three groups: Group 1—SRA: single anastomosis (n = 264, 85%);
Group 2—MRA: single conjoined anastomosis (n = 39, 12%); and Group 3—MRA: ≥2
anastomoses (n = 9, 3%). Results: Mean
ischaemia times (donor clamping to graft reperfusion) in the three groups were
14, 21 and 17 minutes respectively. Failure to normalize creatinine within 72
hours was seen in 29/264 (11%), 4/39 (10.2%) and 1/9 (11%), (P >0.05). Delayed graft function (attributable to severe rejection) occurred
in only one patient who was from group 2. One-year graft survival among the
groups was 243/264 (92%), 35/39 (90%) and 8/9 (89%), (P > 0.05). One patient from groups 1 and 2 developed transplant renal artery
stenosis. Two patients from group 1 needed stenting for ureteric stenosis. Conclusions: Donor grafts with MRA may be accepted safely with careful surgical reconstruction
and close surveillance post-transplant.