Technical problems in living donor transplantation.

Inferior outcomes are generally described with grafts having multiple arteries or renovascular disease. A consecutive series of 261 living donor (LD) transplants performed in the CsA era was classified in three groups with regard to the graft arterial abnormalities and the techniques employed for revascularization. Two hundred eleven recipients had a kidney with one "healthy" renal artery (Group I); 11 patients, multiple arteries, which were reconstructed by various intracorporeal techniques (Group II); 39 patients, one diseased renal artery or multiple arteries, which were reconstructed on the bench (Group III). One- and 3-year graft survivals not censored for death, were 91%, 82%, 100% and 87%, 82%, 100%, respectively, for Group I, Group II, and Group III. An aggressive policy in performing microsurgical bench reconstruction, also for kidneys with one artery that are affected by intrinsic disease, allowed us to obtain a 3-year graft survival of 100% in our more recent consecutive series of 53 LD transplants.