GRAFT AND PATIENT OUTCOMES IN RECIPIENTS OF GRAFTS WITH MULTIPLE RENAL ARTERIES.

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GRAFT AND PATIENT OUTCOMES IN RECIPIENTS OF GRAFTS WITH MULTIPLE RENAL ARTERIES.
Ozgur Basaran MD , Gokhan Moray MD , Remzi Emiroglu MD , Feride Alevli MD and Mehmet Haberal MD,FACS . Ankara Turkey, Baskent University Faculty of Medicine, 06490, General Surgery and Transplantation .

Anastomosisis of MRA in living-donor kidney transplantation is technically demanding, and this condition was once considered a relative contraindication due to increased risk of vascular and urologic complications. Seventy-nine (7.2%) of the cases required multiple-artery anastomosis (Group I) and 1016 (92.8%) cases required single-artery anastomosis (Group II). Regarding early complications in the 79 MRA cases, one (1.3%) patient developed hyperacute graft rejection, another patient (1.3%) had to undergo graft nephrectomy due to massive bleeding at the incision site. Polar artery thrombosis occurred in two patients (2.5%) in the early-postoperative period. Two patients (2.5%) developed lymphoceles. Three (3.8%) of the patients with MRA grafts developed renal artery stenosis. There were no significant differences between Groups I and II with respect to creatinine clearance at 1 year (84±12.1 versus 82±13.7 mg/min, respectively); cold ischemia time at 1 year (90.00±10.1 vs 82.8±12.1 min, respectively); or serum creatinine values at 1 year (1.0±0.7 vs 1.1±0.5 mg/dL, respectively), 2 years (1.2±0.2 vs 1.3±0.8 mg/dL, respectively) and 5 years (1.3±0.6 vs 1.7±1 mg/dl, respectively)(p<0.05 for all). There were also no significant differences between the groups with respect to rate of post-transplantation hypertension (p=0.67), acute tubular necrosis (p=0.55), or number of acute rejection episodes (p=0.34). The respective graft survival rates at 1 and 5 years post-transplantation were 95.1% and 73.2% in Group I, and 95.0% and 79% in Group II. The corresponding patient survival rates were 95% and 88% for Group I, and 97.1% and 83.1% for Group II. These findings indicate that kidney grafts with multiple arteries can be used with excellent results.