Kadotani Y, Okamoto M, Akioka K, Ushigome H, Ogino S, Nobori S, Higuchi A, Wakabayashi Y, Kaihara S, Yoshimura N
Department of Transplantation and Regenerative Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Transplant Proc. 2005 Mar;37(2):1049-51. doi: 10.1016/j.transproceed.2005.01.033.
The shortage of grafts in living kidney transplantation has forced the use of marginal grafts with arterial disease or grafts with multiple renal arteries (MRA). We reviewed the outcomes of transplants using allografts with MRA procured by open donor nephrectomy and report two cases requiring vascular reconstruction.
We reviewed 31 cases where renovascular reconstruction of an MRA graft was performed. A ex vivo pantaloon (side-to-side) anastomosis to create a common channel was performed in 24 cases including two cases of renal artery aneurysms in the grafts, where vascular reconstruction was performed in the same fashion after resection of the aneurysm. In four cases, an accessory artery was anastomosed sequentially after revasculization of the main artery. In three cases of grafts with multiple renal arteries, multiple anastomoses were done in situ after various ex vivo renovascular reconstructions.
Twenty one MRA grafts including grafts with a renal aneurysm are functioning well for a mean follow-up 135 months. The graft survival rate was 71.0% at 5 years after transplantation and 67.7% at 10 years. The donors whose grafts had a renal aneurysm were also well and normotensive with normal renal function at present. Ten grafts failed mainly due to chronic allograft nephropathy.
MRA grafts procured by open nephrectomy, including those with renal artery aneurysms, were engrafted successfully by applying appropriate renovascular surgery. The use of those grafts was safe for both the recipient and the donor.
活体肾移植中移植物的短缺迫使人们使用患有动脉疾病的边缘移植物或有多条肾动脉（MRA）的移植物。我们回顾了通过开放性供体肾切除术获取的带有MRA的同种异体移植物的移植结果，并报告了两例需要血管重建的病例。
我们回顾了31例行MRA移植物肾血管重建的病例。24例进行了体外裤型（端侧）吻合以创建一个共同通道，其中包括两例移植物肾动脉动脉瘤，在切除动脉瘤后以相同方式进行血管重建。4例中，在主肾动脉血运重建后依次吻合副肾动脉。3例有多条肾动脉的移植物，在进行各种体外肾血管重建后原位进行多处吻合。
包括有肾动脉瘤的移植物在内的21个MRA移植物功能良好，平均随访135个月。移植后5年移植物存活率为71.0%，10年为67.7%。其移植物有肾动脉瘤的供体目前情况良好，血压正常，肾功能正常。10个移植物失败主要是由于慢性移植肾肾病。
通过开放性肾切除术获取的MRA移植物，包括那些有肾动脉动脉瘤的移植物，通过应用适当的肾血管手术成功植入。这些移植物对受体和供体都是安全的。
