Kadotani Yayoi, Okamoto Masahiko, Akioka Kiyokazu, Ushigome Hidetaka, Ogino Shiro, Nobori Shuji, Higuchi Atsushi, Wakabayashi Yoshihiro, Kaihara Satoshi, Yoshimura Norio
Department of Transplantation and Regenerative Surgery, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto, 602-8566, Japan.
Surg Today. 2005;35(6):459-66. doi: 10.1007/s00595-004-2967-2.
Kidney allografts with multiple renal arteries (MRAs) have been used with increasing frequency since the advent of laparoscopic live donor nephrectomy. To determine if MRA grafts affect the short- and long-term outcomes of grafts and patients, we analyzed 340 grafts procured by open nephrectomy.
We divided the graft recipients into five groups according to the methods used for vascular reconstruction. We compared patient and graft survival, serum creatinine levels, total (rewarm) ischemic times (TIT), incidence of acute tubular necrosis (ATN), need for antihypertensive drugs, incidence of acute rejection episodes, and vascular and urologic complications, between the MRA group and a control group of patients with single-artery renal grafts.
In patients who underwent multiple anastomoses in situ, prolonged TIT resulted in an increased incidence of ATN, but there was no significant difference between the MRA groups and the control group (P = 0.45). The incidence of vascular complications was higher in the MRA groups (P < 0.01), but there were no significant differences in the other variables among the groups.
Multiple renal artery grafts procured by open nephrectomy can be transplanted as successfully as those with single arteries, by using meticulous suturing techniques.
自腹腔镜活体供肾肾切除术出现以来，多支肾动脉（MRA）的肾移植使用频率不断增加。为了确定MRA移植肾是否会影响移植肾和患者的短期及长期预后，我们分析了340例通过开放性肾切除术获取的移植肾。
根据血管重建所用方法，我们将移植肾受者分为五组。我们比较了MRA组和单动脉肾移植患者对照组之间的患者和移植肾存活率、血清肌酐水平、总（复温）缺血时间（TIT）、急性肾小管坏死（ATN）发生率、降压药物需求、急性排斥反应发生率以及血管和泌尿系统并发症。
在原位进行多次吻合的患者中，TIT延长导致ATN发生率增加，但MRA组与对照组之间无显著差异（P = 0.45）。MRA组血管并发症发生率较高（P < 0.01），但各组间其他变量无显著差异。
通过开放性肾切除术获取的多支肾动脉移植肾，采用精细的缝合技术，可与单支动脉移植肾一样成功移植。
