Kidney Transplantation in Case of Renal Graft with Multiple Arteries: Challenges and Long-Term Results of Microsurgical Anastomosis Between Lower Polar Renal Artery and Inferior Epigastric Artery.

In the current era of solid organ transplantation, the gap between available donors and patients on the waiting list is widening. Worldwide, surgeons are confronted with the challenge of optimizing the utilization of renal grafts, including the presence of multiple renal arteries (MRA), occurring in 20% to 30% of cases. The presence of a lower polar artery (LPA), which provides a significant vascular contribution to both the lower renal parenchyma and the upper urinary tract, constitutes an additional challenge, but its preservation is fundamental for the outcome of the kidney transplant (KT). The end-to-end (E/E) anastomosis with the recipient's inferior epigastric artery (IEA) has been rarely reported in the literature, with variable results. The aim of this study is to report on technical aspects as well as on short- and long-term outcomes of this reconstruction in KT. A retrospective three-centre analysis was conducted on 13 KTs in which the graft's LPA was anastomosed E/E with the recipient's IEA. Following an average follow-up period of 84 months, the patient and graft survival rate was 100%. Neither vascular nor urological complications were observed. In the event of KT with LPA, an E/E anastomosis with IEA performed with microsurgical technique is safe and provides excellent long-term results.