Scheuermann Uwe, Rademacher Sebastian, Wagner Tristan, Lederer Andri, Hau Hans-Michael, Seehofer Daniel, Sucher Robert
Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany.
Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany.
J Clin Med. 2021 Sep 26;10(19):4395. doi: 10.3390/jcm10194395.
Complex arterial reconstruction in kidney transplantation (KT) using kidneys from deceased donors (DD) warrants additional study since little is known about the effects on the mid- and long-term outcome and graft survival.
A total of 451 patients receiving deceased donor KT in our department between 1993 and 2017 were included in our study. Patients were divided into three groups according to the number of arteries and anastomosis: (A) 1 renal artery, 1 arterial anastomosis ( = 369); (B) >1 renal artery, 1 arterial anastomosis ( = 47); and (C) >1 renal artery, >1 arterial anastomosis ( = 35). Furthermore, the influence of localization of the arterial anastomosis (common iliac artery (CIA), versus non-CIA) was analyzed. Clinicopathological characteristics, outcome, and graft and patient survival of all groups were compared retrospectively.
With growing vascular complexity, the time of warm ischemia increased significantly (groups A, B, and C: 40 ± 19 min, 45 ± 19 min, and 50 ± 17 min, respectively; = 0.006). Furthermore, the duration of operation was prolonged, although this did not reach significance (groups A, B, and C: 175 ± 98 min, 180 ± 35 min, and 210 ± 43 min, respectively; = 0.352). There were no significant differences regarding surgical complications, post-transplant kidney function (delayed graft function, initial non-function, episodes of acute rejection), or long-term graft survival. Regarding the localization of the arterial anastomosis, non-CIA was an independent prognostic factor for deep vein thrombosis in multivariate analysis (CIA versus non-CIA: OR 11.551; 95% CI, 1.218-109.554; = 0.033).
Multiple-donor renal arteries should not be considered a contraindication to deceased KT, as morbidity rates and long-term outcomes seem to be comparable with grafts with single arteries and less complex anastomoses.
由于对于肾移植（KT）中使用来自 deceased donors（DD）的肾脏进行复杂动脉重建对中长期结局和移植物存活的影响知之甚少，因此有必要进行进一步研究。
本研究纳入了 1993 年至 2017 年期间在我科接受 deceased donor KT 的 451 例患者。根据动脉数量和吻合情况将患者分为三组：（A）1 条肾动脉，1 次动脉吻合（n = 369）；（B）>1 条肾动脉，1 次动脉吻合（n = 47）；（C）>1 条肾动脉，>1 次动脉吻合（n = 35）。此外，分析了动脉吻合部位（髂总动脉（CIA）与非 CIA）的影响。对所有组的临床病理特征、结局以及移植物和患者存活情况进行回顾性比较。
随着血管复杂性增加，热缺血时间显著延长（A、B、C 组分别为 40±19 分钟、45±19 分钟和 50±17 分钟；P = 0.006）。此外，手术时间延长，尽管未达到显著水平（A、B、C 组分别为 175±98 分钟、180±35 分钟和 210±43 分钟；P = 0.352）。在手术并发症、移植后肾功能（移植肾功能延迟、初始无功能、急性排斥发作）或长期移植物存活方面无显著差异。关于动脉吻合部位，在多因素分析中，非 CIA 是深静脉血栓形成的独立预后因素（CIA 与非 CIA：OR 11.551；95%CI，1.218 - 109.554；P = 0.033）。
多供体肾动脉不应被视为 deceased KT 的禁忌证，因为发病率和长期结局似乎与单动脉且吻合不太复杂的移植物相当。
