Abstract
Background/objectives
The aim of this retrospective study was to evaluate the repair of vascular variations/pathologies in living donor kidney transplantations in a single centre over a 15-year period.
Methods
Between 01/1997 and 05/2012, 338 living donor renal transplantations were performed in the Department for Endovascular and Vascular Surgery, University of Düsseldorf, Germany. Twenty-four of them showed disorders, like multiple renal arteries (MRA), atherosclerotic stenosis or fibromuscular dysplasia (FMD) needing vascular repair before transplantation.
Results
Mean age of donors was 51 ± 11.2, in recipient’s 44 ± 13.9 years. In seven transplantations, renal artery (RA) repair was performed because of MRA. Atherosclerotic stenosis of the RA was apparent in 12 cases needing a repair with disobliteration. FMD was the reason in five transplantations for vascular repair. Complications like renal vessel thrombosis, lymphocele, heamorrhage, distal urinary leakage and ureteral obstruction was not significantly associated with RA reconstruction. Comparison of renal function in kidneys with reconstructed RA compared with kidneys without vascular repair showed no significant difference in primary function and serum creatinine up to the first year after transplantation. Mean follow-up was 75.6 ± 48.1 months. The 5-year graft survival rate for kidneys with RA repair was 88.5 vs. 93.4 % without reconstruction.
Conclusions
We could show that RA pathologies, suitable repaired, are not a contraindication for transplantation with acceptable 5-year-graft-survival rates.
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References
Fehrman-Ekholm I, Duner F, Brink B, Tydén G, Elinder CG (2001) No evidence of accelerated loss of kidney function in living kidney donors: results from a crosssectional follow-up. Transplantation 72:444–449
Friedman AL, Peters TG, Jones KW, Boulware LE, Ratner LE (2006) Fatal and nonfatal hemorrhagic complications of living kidney donation. Ann Surg 243:126–130
Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H et al (2009) Long-term consequences of kidney donation. N Engl J Med 360:459–469
Indudhara R, Kenney, Bueschen AJ, Burns JR (1999) Live donor nephrectomy in patients with fibromuscular dysplasia of the renal arteries. J Urol 162:678–681
Nahas WC, Lucon AM, Mazzucchi E, Scafuri AG, Neto ED, Ianhez LE et al (1998) Kidney transplantation: the use of living donors with renal artery lesions. J Urol 160:1244–1247
Serrano DP, Flechner SM, Modlin CS, Streem SB, Goldfarb DA, Novick AC (1997) The use of kidneys from living donors with renal vascular disease: expanding the donor pool. J Urol 157:1587–1591
Wolters HH, Vowinkel T, Schult M, Heidenreich S, Senninger N, Dietl KH (2002) Fibromuscular dysplasia in a living donor: early post-operative allograft artery stenosis with successful venous interposition. Nephrol Dial Transplant 17:153–155
Andrews PA, Burnapp L, Manas D, Bradley JA, Dudley C, British Transplantation Society Renal Association (2012) Summary of the British Transplantation Society/Renal Association U.K. guidelines for living donor kidney transplantation. Transplantation 93:666–673
Roza AM, Perloff LJ, Naji A, Grossman RA, Barker CF (1989) Living-related donors with bilateral multiple renal arteries. A twenty-year experience. Transplantation 47:397–399
Hakim N, Danowitch G (2001) Transplantation surgery, 1st edn. Springer, London
Benedetti E, Troppmann C, Gillingham K, Sutherland DE, Payne WD, Dunn DL et al (1995) Short- and long-term outcomes of kidney transplants with multiple renal arteries. Ann Surg 221:406–414
Kadotani Y, Okamoto M, Akioka K, Ushigome H, Ogino S, Nobori S et al (2005) Renovascular reconstruction of grafts with renal artery variations in living kidney transplantation. Transplant Proc 37:1049–1051
Andersen OS, Clark SS, Marlett MM, Jonasson O (1976) Treatment of extensive renal calculi with extracorporeal surgery and autotransplantation. Urology 7:465–469
Gondos A, Döhler B, Brenner H, Opelz G (2013) Kidney graft survival in Europe and the United States: strikingly different long-term outcomes. Transplantation 95:267–274
Osman Y, Shokeir A, Ali-el-Dein B, Tantawy M, Wafa EW, el-Dein AB et al (2003) Vascular complications after live donor renal transplantation: study of risk factors and effects on graft and patient survival. J Urol 169:859–862
Bakir N, Sluiter WJ, Ploeg RJ, van Son WJ, Tegzess AM (1996) Primary renal graft thrombosis. Nephrol Dial Transplant 11:140–147
Galazka Z, Szmidt J, Nazarewski S, Grochowiecki T, Swiercz P, Bojakowska M et al (2002) Long-term results of kidney transplantation in recipients with atherosclerotic iliac arteries. Transplant Proc 34:604–605
Humar A, Matas AJ (2005) Surgical complications after kidney transplantation. Semin Dial 18:505–510
Buturovic-Ponikvar J (2003) Renal transplant artery stenosis. Nephrol Dial Transplant 18:S74–S77
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Sagban, T.A., Baur, B., Rump, L.C. et al. Long-term graft outcome after renal arterial reconstruction during living related kidney transplantation. Langenbecks Arch Surg 399, 441–447 (2014). https://doi.org/10.1007/s00423-014-1167-9
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DOI: https://doi.org/10.1007/s00423-014-1167-9