Johnston T, Reddy K, Mastrangelo M, Lucas B, Ranjan D
Department of Surgery, University of Kentucky, Lexington, USA.
Clin Transplant. 2001;15 Suppl 6:62-5. doi: 10.1034/j.1399-0012.2001.00012.x.
Since the first description by Ratner and collegues in 1996, laparoscopic live-donor nephrectomy is gaining wide acceptance in an attempt to minimize the donor morbidity, length of hospital stay and length of time to return to work. It is unknown whether multiple renal arteries pose additional problems with laparoscopic donor nephrectomy. In November 1998, our institution initiated laparoscopic donor nephrectomy program. In the ensuing 19 months, we performed 25 living donor renal transplants, 24 of them using laparoscopic donor nephrectomy. The left kidney was procured in all cases. Eight donor candidates (33%) had two or more renal arteries (two arteries in five patients and three patients).
In six cases (25%), findings at surgery differed from the CT angography results (in four cases, CT angiogram reported fewer arteries than were found at surgery and in two cases it reported more). We found no significant differences in both donor outcomes and recipient, based on the presence or absence of multiple renal arteries. Among donor outcomes, we found equivalent results for donor warm ischemia time total donor operating time, and donor length of stay. For recipient outcomes, we found no significant differences between groups for the incidence of acute tubular necrosis (ATN), graft survival and most recent serum creatinine. In one case, we constructed two arteries into a single conduit on the backtable prior to transplantation. However, in most cases with multiple arteries, we implanted the arteries separately into the recipient external iliac artery. Based on this experience, we do not find the presence of multiple renal arteries to be a barrier to the successful use of kidney grafts procured by laparoscopic donor nephrectomy.
自1996年拉特纳及其同事首次描述以来，腹腔镜活体供肾切除术正被广泛接受，旨在尽量减少供体的发病率、住院时间和恢复工作的时间。尚不清楚多条肾动脉是否会给腹腔镜供肾切除术带来额外问题。1998年11月，我们机构启动了腹腔镜供肾切除术项目。在随后的19个月里，我们进行了25例活体供肾移植，其中24例采用腹腔镜供肾切除术。所有病例均获取左肾。8名供体候选人（33%）有两条或更多肾动脉（5例为两条动脉，3例为三条动脉）。
6例（25%）手术所见与CT血管造影结果不同（4例CT血管造影报告的动脉数量少于手术中发现的数量，2例报告的动脉数量更多）。基于是否存在多条肾动脉，我们发现供体和受体的结局均无显著差异。在供体结局方面，我们发现供体热缺血时间、总供体手术时间和供体住院时间的结果相当。对于受体结局，我们发现急性肾小管坏死（ATN）的发生率、移植物存活率和最近的血清肌酐水平在各组之间无显著差异。在1例中，我们在移植前在手术台上将两条动脉构建成一个单一管道。然而，在大多数有多条动脉的病例中，我们将动脉分别植入受体的髂外动脉。基于这一经验，我们发现多条肾动脉的存在并非腹腔镜供肾切除术获取的肾移植成功应用的障碍。
