Fitzpatrick John, Chmelo Jakub, Nambiar Arjun, Fuge Oliver, Page Toby, Sen Gourab, Soomro Naeem, Rix David, Rogers Alistair, Talbot David, Veeratterapillay Rajan
Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom.
Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom.
Urol Ann. 2020 Jul-Sep;12(3):266-270. doi: 10.4103/UA.UA_96_19. Epub 2020 Jul 17.
In kidney transplantation, total laparoscopic live donor nephrectomy (TLLDN) in the presence of multiple renal arteries (MRA) is technically challenging and has traditionally been associated with higher complication rates. We report our experience of using MRA grafts procured by TLLDN.
Patients undergoing TLLDN at our center (2004-2014) was identified from a prospectively maintained database and divided into single renal arteries (SRA) or MRA groups. Recipient perioperative parameters, postoperative complications, and long-term graft survival were analyzed.
Of 465 patients, 106 had MRA and 359 had an SRA. There were six vascular complications in the SRA group and two in the MRA group (1.7% vs. 1.8%). There were eight ureteric complications requiring intervention in the SRA group compared to three in the MRA group (4% vs. 3%; = 0.45). Acute rejection was observed in 12% of the SRA group compared to 9% in the MRA group ( = 0.23). One-, 5- and 10-year graft survivals were 98.2%, 91.3%, and 89.8% in the MRA group versus 98.0%, 90.4%, and 77.5% in the SRA group (log-rank = 0.13).
The use of MRA grafts procured by TLLDN has comparable complication rates to SRA grafts and should not preclude selection for renal transplantation.
在肾移植中，存在多条肾动脉（MRA）时进行完全腹腔镜活体供肾切除术（TLLDN）在技术上具有挑战性，并且传统上与较高的并发症发生率相关。我们报告了使用通过TLLDN获取的MRA移植物的经验。
从一个前瞻性维护的数据库中识别出在我们中心接受TLLDN的患者（2004 - 2014年），并将其分为单条肾动脉（SRA）组或MRA组。分析受者围手术期参数、术后并发症和长期移植物存活率。
465例患者中，106例有MRA，359例有SRA。SRA组有6例血管并发症，MRA组有2例（1.7%对1.8%）。SRA组有8例输尿管并发症需要干预，而MRA组有3例（4%对3%；P = 0.45）。SRA组12%观察到急性排斥反应，MRA组为9%（P = 0.23）。MRA组1年、5年和10年移植物存活率分别为98.2%、91.3%和89.8%，SRA组分别为98.0%、90.4%和77.5%（对数秩检验P = 0.13）。
使用通过TLLDN获取的MRA移植物与SRA移植物的并发症发生率相当，不应排除用于肾移植的选择。
