Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.
Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida.
Transpl Int. 2022 Apr 14;35:10212. doi: 10.3389/ti.2022.10212. eCollection 2022.
Multiple renal arteries (MRA) are often encountered during living-donor kidney transplantation (LDKT), requiring surgeons to pursue complex renovascular reconstructions prior to graft implantation. With improvements in reconstruction and anastomosis techniques, allografts with MRA can be successfully transplanted with similar outcomes to allografts with a single renal artery. Here, we describe in detail various surgical techniques for reconstruction of MRA grafts with the intent of creating a single arterial inflow. We retrospectively reviewed the medical records of all LDKT recipients with laparoscopically procured MRA kidneys between March 2008 and July 2021. Recipient and donor characteristics, operative data, type of reconstruction, and recipient outcomes were analyzed. The primary outcomes were the incidence of developing delayed graft function (DGF) and/or a vascular or urological complication within 12 months post-transplant. Seventy-three LDKT recipients of MRA donor allografts were evaluated. Two renal arteries (RA) were encountered in 62 allografts (84.9%) and three RA in 11 allografts (15.1%). Renal artery reconstruction was performed in 95.8% (70/73) of patients. Eighteen different reconstruction techniques of MRA were utilized, the most common being side-to-side anastomosis in allografts with two RA ( = 44) and side-to-side-to-side anastomosis in allografts with three RA ( = 4). Interposition grafting was performed in seven cases (9.6%). A single ostium was created in 69 cases (94.5%), and the median warm ischemia time was 27 (range 20-42) minutes. None of the patients developed DGF or post-operative vascular or urological complications. Median creatinine at 3, 6, and 12 months post-transplant remained stable at 1.1 mg/dl. With a median follow-up of 30.4 months post-transplant, only one graft failure has been observed-death-censored graft survival was 98.6%. Complex reconstruction techniques to create a single renal artery ostium for graft implantation anastomosis in allografts with MRA show acceptable warm ischemic times, with no increased risk of post-operative vascular or urological complications.
多支肾动脉（MRA）在活体供肾移植（LDKT）中经常遇到，需要外科医生在移植前进行复杂的肾血管重建。随着重建和吻合技术的改进，MRA 供体移植物可以成功移植，其结果与单支肾动脉供体移植物相似。在这里，我们详细描述了各种 MRA 移植物重建的手术技术，旨在创建单一的动脉流入。我们回顾性分析了 2008 年 3 月至 2021 年 7 月间腹腔镜获取 MRA 供体肾脏的所有 LDKT 受者的病历。分析了受者和供者特征、手术数据、重建类型和受者结局。主要结局是移植后 12 个月内发生延迟移植物功能（DGF）和/或血管或尿路上的并发症的发生率。评估了 73 例 MRA 供体移植物的 LDKT 受者。62 例（84.9%）供体中有 2 支肾动脉，11 例（15.1%）供体中有 3 支肾动脉。95.8%（70/73）的患者进行了肾动脉重建。共使用了 18 种不同的 MRA 重建技术，最常见的是 2 支肾动脉供体的侧侧吻合（=44）和 3 支肾动脉供体的侧侧侧吻合（=4）。7 例（9.6%）进行了间置移植。69 例（94.5%）创建了单一口，热缺血时间中位数为 27（20-42）分钟。无患者发生 DGF 或术后血管或尿路上的并发症。移植后 3、6、12 个月的肌酐中位数稳定在 1.1mg/dl。移植后中位随访 30.4 个月，仅观察到 1 例移植物失功-死亡风险的移植物存活率为 98.6%。对于 MRA 供体移植物，创建单一肾动脉口进行吻合的复杂重建技术显示出可接受的热缺血时间，术后血管或尿路上的并发症风险无增加。
