Tiwari Brijesh, Pandey Pranchil, G Vezhaventhen, K Saravanan
Urology, Shyam Shah Medical College, Rewa, IND.
Anaesthesiology, Shyam Shah Medical College, Rewa, IND.
Cureus. 2022 May 23;14(5):e25262. doi: 10.7759/cureus.25262. eCollection 2022 May.
Introduction Renal transplantation with multiple arteries is associated with a major index of surgical complications. Relevant papers and meta-analyses have shown relatively more vascular and urological complications in transplant of donor kidneys with multiple arteries. In live donor grafts due to the unavailability of a carrel patch, several techniques for bench and in situ reconstruction have been described in order to reduce the incidence of these vascular complications. In this study, the short and long-term results of living donor kidney transplants with multiple renal arteries (MRAs) versus single renal artery (SRA) were compared retrospectively. Methods This is a retrospective study done on patients who received a living donor kidney between January 2012 and January 2018 attheInstitute of Urology Madras Medical College, Chennai. We have excluded deceased donor kidney transplants and ABO-incompatible cases done in the same time period. The study was approved by the Institutional Ethics Committee (Approval No: IES-MMC-008) and performed in accordance with the guidelines of the Declaration of Helsinki. Open live donor nephrectomy was performed through an extra-peritoneal flank incision in all cases. In the SRA group, the renal artery was anastomosed end to end to the Internal iliac artery, while the renal vein was anastomosed to the external iliac vein in the end to side fashion. Urinary tract reconstruction was accomplished by the Gregoir technique in both groups. We looked at recipient complications, baseline and postoperative serum creatinine, total ischemia time, mean operating time, and short- and long-term graft and patient survival as postoperative outcomes. Results In a six-year period (2012-2018) at our institute, 256 living donor transplantations were performed; 36 (14%) kidneys had two or more renal arteries which were anastomosed using various techniques. Cold ischemia time was relatively longer in the MRA group (45 mins vs 28 mins in the SRA group) (p-value <0.05). while warm ischemia time was comparable in both groups (2.5 vs 2.9 mins) serum creatinine was comparable in both groups at the 30th postoperative day (1.4 in SRA group vs 1.2 in MRA group) (p-value >0.05). Incidence of surgical complications in SRA and MRA groups was: vascular - 3.6% and 2.7%; urological - 3.2% and 2.7%; the incidence of lymphocele was 4.5% and 5.5% and delayed graft function 4.5% and 5.5% respectively. Conclusion Multiple renal arteries are no longer a relative contraindication with advanced surgical techniques. in renal grafts with multiple arteries, all techniques of vessel anastomosis are comparable in terms of post-surgical complications.
多支动脉的肾移植与主要手术并发症指标相关。相关论文和荟萃分析表明，多支动脉供肾移植中血管和泌尿系统并发症相对较多。在活体供肾移植中，由于无法使用卡雷尔补片，已描述了几种在体外操作台上和原位重建的技术，以降低这些血管并发症的发生率。本研究回顾性比较了多支肾动脉（MRA）与单支肾动脉（SRA）活体供肾移植的短期和长期结果。
这是一项对2012年1月至2018年1月在金奈马德拉斯医学院泌尿外科研究所接受活体供肾移植的患者进行的回顾性研究。我们排除了同期进行的尸体供肾移植和ABO血型不相容的病例。该研究经机构伦理委员会批准（批准号：IES-MMC-008），并按照《赫尔辛基宣言》的指导原则进行。所有病例均通过腹膜外侧面切口进行开放性活体供肾切除术。在SRA组中，肾动脉与髂内动脉端端吻合，而肾静脉与髂外静脉端侧吻合。两组均采用格雷戈尔技术进行尿路重建。我们将受体并发症、基线和术后血清肌酐、总缺血时间、平均手术时间以及移植肾和患者的短期和长期生存率作为术后结果进行观察。
在我们研究所的六年期间（2012 - 2018年），共进行了256例活体供肾移植；36例（14%）肾脏有两支或更多肾动脉，采用了各种技术进行吻合。MRA组的冷缺血时间相对较长（45分钟，而SRA组为28分钟）（p值<0.05）。而热缺血时间在两组中相当（2.5分钟对2.9分钟），术后第30天两组血清肌酐相当（SRA组为1.4，MRA组为1.2）（p值 >0.05）。SRA组和MRA组的手术并发症发生率分别为：血管并发症 - 3.6%和2.7%；泌尿系统并发症 - 3.2%和2.7%；淋巴囊肿发生率分别为4.5%和5.5%，移植肾功能延迟分别为4.5%和5.5%。
随着先进手术技术的应用，多支肾动脉不再是相对禁忌证。在有多支动脉的肾移植中，就手术并发症而言，所有血管吻合技术相当。
