Division of Transplantation Surgery, Department of Surgery and William von Liebig Transplant Center, Mayo Clinic, Rochester, MN 55905, USA.
J Am Coll Surg. 2013 Jul;217(1):144-52; discussion 152. doi: 10.1016/j.jamcollsurg.2013.04.010.
The use of kidneys with multiple renal arteries (MRA) and right kidneys procured laparoscopically for living donor kidney transplantation (LDKT) remains controversial. We aimed to evaluate the short- and long-term outcomes of recipients of LDKT using laparoscopically procured MRA and right kidneys.
We reviewed the medical records of all LDKT recipients with laparoscopically procured kidneys from 2000 to 2009. Pediatric recipients and recipients of positive crossmatch and/or ABO-incompatible transplants were excluded. We compared the outcomes of recipients of MRA kidneys with those receiving single renal artery (SRA) kidneys and the outcomes of recipients of right kidneys with those of left kidneys. Renal function was measured by iothalamate clearance and estimated by the abbreviated Modification of Diet in Renal Disease equation.
Multiple renal artery kidneys (192 2-artery and 18 3-artery kidneys) were used in 210 (18.5%) of 1,134 transplantations. The most common reconstructive technique used for MRA kidneys was a side-to-side anastomosis (64.3%). There were no significant differences in vascular complications (1.1% vs 2.4%, p = 0.17), urologic complications (3.1% vs 2.9%, p = 0.47), graft survival at 1 year (94.6% vs 96.1%, p = 0.37), and 1-year iothalamate clearance (64 mL/min/1.73 m(2) vs 66 mL/min/1.73 m(2), p = 0.52) between recipients of SRA and MRA kidneys. Five-year graft survival was similar for recipients of SRA and MRA kidneys (83.6% vs 82.6%, p = 0.82) and for recipients of left vs right kidneys (83.7% vs 82.6%, p = 0.70).
Excellent long-term outcomes can be obtained after LDKT using laparoscopically procured MRA and right-sided donor kidneys. Unavailability of an SRA left kidney should not preclude LDKT.
使用具有多支肾动脉（MRA）的肾脏和腹腔镜获取的右肾进行活体供肾移植（LDKT）仍然存在争议。我们旨在评估使用腹腔镜获取 MRA 和右肾进行 LDKT 的受者的短期和长期结果。
我们回顾了 2000 年至 2009 年所有使用腹腔镜获取肾脏的 LDKT 受者的病历。排除小儿受者、交叉配型阳性和/或 ABO 不相容移植的受者。我们比较了 MRA 肾脏受者与单支肾动脉（SRA）肾脏受者的结果，以及右肾受者与左肾受者的结果。通过碘酞酸盐清除率测量肾功能，并通过简化的肾脏病饮食修正公式估算。
1134 例移植中，192 例（18.5%）使用多支肾动脉肾脏（18 例 3 支动脉，192 例 2 支动脉）。用于 MRA 肾脏的最常见重建技术是侧侧吻合（64.3%）。MRA 肾脏组与 SRA 肾脏组在血管并发症（1.1%比 2.4%，p=0.17）、泌尿道并发症（3.1%比 2.9%，p=0.47）、1 年移植物存活率（94.6%比 96.1%，p=0.37）和 1 年碘酞酸盐清除率（64ml/min/1.73m2 比 66ml/min/1.73m2，p=0.52）方面无显著差异。SRA 肾脏组和 MRA 肾脏组的 5 年移植物存活率相似（83.6%比 82.6%，p=0.82），左肾与右肾的存活率也相似（83.7%比 82.6%，p=0.70）。
使用腹腔镜获取的 MRA 和右侧供肾进行 LDKT 可获得良好的长期结果。如果没有可用的 SRA 左侧肾脏，不应排除 LDKT。
