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Troubleshooting Complex Vascular Cases in the Kidney Graft: Multiple Vessels, Aneurysms, and Injuries During Harvesting Procedures


Purpose of the Review

To update the most relevant literature regarding complex vascular cases in kidney transplant setting involving the graft, especially during the harvesting procedure and back-table preparation from the subsequent implant.

Recent Findings

Challenging situations affecting the kidney graft such as multiple vessels, renal artery aneurysms, kidney anatomical anomalies, or major injuries do not contraindicate the transplant, but require an exhaustive graft viability assessment and several bench surgery techniques. Graft vessel conditioning in the back-table might include simple anastomosis between them, enlarging with venous patch or reconstruction with donor or synthetic grafts. Compared with conventional transplant, literature reports longer warm ischemia time (40 vs 32 min) and slightly increased rates of delayed graft function (10.3% vs 8.2%) and vascular complications (10.8% vs 8.1%), but similar graft and patient survival.


Kidney graft vascular complex cases require exhaustive assessment, meticulous harvesting, good surgical technique in the bench table, and proper surgery in the recipient. Despite its complexity, vascular complex kidney transplant offers comparable outcomes in the long term to conventional population when technically well performed, with slightly increased rates of vascular complications and delayed graft function.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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The authors would like to acknowledge Dr. Gaetano Ciancio for his generosity giving some pictures and for being a permanent reference in the field of transplantation and renal surgery.

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Correspondence to Vital Hevia.

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Vital Hevia, Victoria Gómez, Manuel Hevia, Javier Lorca, Marta Santiago, Jose López-Plaza, Sara Álvarez, Víctor Díez, Cristina Gordaliza, and Francisco Javier Burgos each declares no potential conflicts of interest.

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Hevia, V., Gómez, V., Hevia, M. et al. Troubleshooting Complex Vascular Cases in the Kidney Graft: Multiple Vessels, Aneurysms, and Injuries During Harvesting Procedures. Curr Urol Rep 21, 5 (2020).

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  • Kidney transplant
  • Complex vascular transplant
  • Multiple vessels
  • Renal artery aneurysm
  • Bench surgery reconstruction