Roth Nadina, Kalteis Manfred, Krause Axel, Rösch Christiane Sophie, Huber Jürgen, Enkner Wolfgang, Haller Maria, Cejka Daniel, Függer Reinhold, Biebl Matthias
Surgical Department for General, Visceral, Thoracic and Transplant Surgery, Ordensklinikum Linz Elisabethinen, Linz, Austria.
Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria.
Front Transplant. 2024 Dec 6;3:1488277. doi: 10.3389/frtra.2024.1488277. eCollection 2024.
In living donor kidney transplantation (LDKT), vascular anastomosis is more difficult due to missing arterial patches and shorter renal veins. The surgical challenge is even more demanding in kidneys with multiple arteries. Although renal transplantation is feasible in most cases of complex donor vascular anatomy and similar results compared with standard LDKT are reported, the discussion on potentially increased complication rates and graft function continues. This prompted us to review our results of LDKT with multiple renal artery (MRA) grafts with a special concentration on complications and long-term function.
We reviewed the records of all LDKT in our center from the beginning of the program in 2005 until 2022 for arterial vascular reconstructions. The cohort was divided into two groups: transplantation with vascular reconstruction (VR) and standard transplantation. These groups were compared for operative parameters and short- and long-term results.
From 2005 to 2022, 211 LDKT were completed in our unit. In 32 (15.2%), a VR was performed, including single ostium side-to-side anastomosis, end-to-side anastomosis, patch reconstruction, and vein interposition. There was no significant difference in operative time (169 min vs. 180 min; = 0.118) and time for anastomosis (28 min vs. 26 min; = 0.59) between both groups. Postoperative complications (5.7% vs. 7.4%; = 0.72) were not significantly different. During the follow-up period (110 months, range 10-204), the risk of organ loss was comparable after VR (13.625% vs. 11.56% = 0.69).
In LDKT, arterial vascular reconstructions for kidneys with MRA provide similar results compared to grafts with a single renal artery (SRA). Short- and long-term results are comparable with standard procedures.
在活体供肾肾移植（LDKT）中，由于缺少动脉补片和肾静脉较短，血管吻合更为困难。对于有多支动脉的肾脏，手术挑战要求更高。尽管在大多数复杂供体血管解剖情况下肾移植是可行的，并且报告的结果与标准LDKT相似，但关于潜在增加的并发症发生率和移植物功能的讨论仍在继续。这促使我们回顾我们的多支肾动脉（MRA）移植物的LDKT结果，特别关注并发症和长期功能。
我们回顾了2005年项目开始至2022年期间我们中心所有LDKT的动脉血管重建记录。该队列分为两组：血管重建（VR）移植组和标准移植组。比较两组的手术参数以及短期和长期结果。
2005年至2022年，我们单位共完成211例LDKT。其中32例（15.2%）进行了VR，包括单开口端侧吻合、端端吻合、补片重建和静脉移植。两组之间的手术时间（169分钟对180分钟；P = 0.118）和吻合时间（28分钟对26分钟；P = 0.59）无显著差异。术后并发症发生率（5.7%对7.4%；P = 0.72）也无显著差异。在随访期（110个月，范围10 - 204个月）内，VR后器官丢失风险相当（13.625%对11.56%；P = 0.69）。
在LDKT中，MRA肾脏的动脉血管重建与单支肾动脉（SRA）移植物相比结果相似。短期和长期结果与标准手术相当。
