From the Department of General Surgery, Baskent University, Ankara, Turkey.
Exp Clin Transplant. 2021 Jan;19(1):14-19. doi: 10.6002/ect.2020.0339. Epub 2020 Sep 17.
Multiple renal vessels are often detected in living and deceased organ donors. In the past, transplant with multiple renal vessel grafts has been a contraindication because of high vascular and urological complication rates. However, improvements in vascular reconstruction and anastomosis techniques have allowed graft function to be maintained for many years. Here, we retrospectively evaluated transplant of multiple renal vessel grafts and graft survival and postoperative vascular and urological complications.
From November 1975 to July 2020, there were 3136 renal transplants (716 deceased donors, 2420 living donors) performed in our center. There were 2167 living donors and 643 deceased donors with single renal vessel grafts and 253 living donors and 73 deceased donors with multiple renal vessel grafts. For anastomoses, external iliac, internal iliac, common iliac, and inferior epigastric arteries and external iliac veins were used. Cold ischemia time, anastomosis time, postoperative vascular and urological complications, acute tubular necrosis, creatinine clearance, serum creatinine levels, graft rejection episodes, and graft and patient survival rates were evaluated.
With regard to creatinine clearance, cold ischemia and anastomosis time, acute tubular necrosis, rejection episodes, and 1-, 2-, and 5-year posttransplant serum creatinine levels, there were no significant differences between the groups. Graft survival rates in the single renal vessel group were 92.9% at 1 year posttransplant and 78.3% at 5 years posttransplant; rates in the multiple renal vessel group were 93.1% at 1 year and 79.7% at 5 years. The corresponding patient survival rates were 95.5% (1 year) and 92.9% (5 years) for the single renal vessel group and 96.9% (1 year) and 87.2% (5 years) for the multiple renal vessel group.
Improved anastomosis and recon struction techniques have allowed the safe transplant of multiple renal vessel grafts that may remain functional for many years.
在活体和已故器官捐献者中，经常会检测到多个肾血管。过去，由于血管和尿路上的并发症发生率较高，多支肾血管移植物移植一直是禁忌症。然而，血管重建和吻合技术的改进使移植物功能能够维持多年。在这里，我们回顾性评估了多支肾血管移植物的移植、移植物存活率以及术后血管和尿路上的并发症。
从 1975 年 11 月至 2020 年 7 月，我们中心进行了 3136 例肾移植（716 例已故供者，2420 例活体供者）。2167 例活体供者和 643 例已故供者接受了单支肾血管移植物，253 例活体供者和 73 例已故供者接受了多支肾血管移植物。用于吻合的血管有髂外动脉、髂内动脉、髂总动脉和腹壁下动脉以及髂外静脉。评估冷缺血时间、吻合时间、术后血管和尿路上的并发症、急性肾小管坏死、肌酐清除率、血清肌酐水平、移植物排斥反应发作以及移植物和患者存活率。
在肌酐清除率、冷缺血和吻合时间、急性肾小管坏死、排斥反应发作以及移植后 1、2 和 5 年的血清肌酐水平方面，两组之间没有显著差异。单支肾血管组 1 年和 5 年的移植物存活率分别为 92.9%和 78.3%；多支肾血管组分别为 93.1%和 79.7%。相应的患者存活率为单支肾血管组 95.5%（1 年）和 92.9%（5 年），多支肾血管组为 96.9%（1 年）和 87.2%（5 年）。
吻合和重建技术的改进使多支肾血管移植物的安全移植成为可能，这些移植物可能在多年后仍能保持功能。
