A 2-mm Cutoff Value Is Reasonable and Feasible for Vascular Reconstruction in a Kidney Allograft With Multiple Arteries

Iwami, Daiki; Hotta, Kiyohiko; Sasaki, Hajime; Hirose, Takayuki; Higuchi, Haruka; Takada, Yuki; Iwahara, Naoya; Shinohara, Nobuo

doi:10.1016/j.transproceed.2019.01.137

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…Proposed by Iwami et al . a cut-off diameter of 2 mm seems worth attempting regarding the success rate and graft function, while cutting of a 2-mm ARA leads to parenchymal loss of less than 8% [ 20 ]. Although the mean diameters of ARAs in both groups differed from 1.88 mm to 3.05 mm, our study did not identify a clear cut-off value for performed anastomosis or ligation in our center.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of the perioperative outcome in living donor kidney transplantation with multiple renal arteries: does accessory vessel ligation affect the outcome?

Schmidt,

Peters,

Mang

et al. 2024

World J Urol

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Purpose Accurate surgical reconstruction of arterial vascular supply is a crucial part of living kidney transplantation (LDKT). The presence of multiple renal arteries (MRA) in grafts can be challenging. In the present study, we investigated the impact of ligation versus anastomosis of small accessory graft arteries on the perioperative outcome. Methods Clinical and radiological outcomes of 51 patients with MRA out of a total of 308 patients who underwent LDKT with MRA between 2011 and 2020 were stratified in two groups and analyzed. In group 1 (20 patients), ligation of accessory arteries (ARAs) and group 2 (31 patients) anastomosis of ARAs was performed. Results Significant differences were observed in the anastomosis-, surgery-, and warm ischemia time (WIT) in favor of group 1. Students t-test showed comparable serum creatinine levels of 2.33 (± 1.75) to 1.68 (± 0.83) mg/dL in group 1 and 2.63 (± 2.47) to 1.50 (± 0.41) mg/dL in group 2, were seen from 1 week to 1 year after transplant. No increased rates of Delayed graft function (DGF), primary transplant dysfunction and transplant rejection were seen, but graft loss and revision rates were slightly higher when the ARAs were ligated. Analysis of Doppler sonography revealed that segmental perfusion deficits tend to regenerate during the clinical course. Conclusion Ligation of smaller accessory renal arteries may not affect the outcome of living kidney transplantation, except for a minor increase in the reoperation rate. Segmental perfusion deficits of the graft seem to regenerate in most cases as seen in Doppler sonography.

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Section: Discussionmentioning

confidence: 99%

Retrospective analysis of the perioperative outcome in living donor kidney transplantation with multiple renal arteries: does accessory vessel ligation affect the outcome?

Schmidt,

Peters,

Mang

et al. 2024

World J Urol

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“…3,4 However, it is challenging to achieve excessive arterial preservation or reconstruction, which may increase the incidence of postoperative complications, such as thrombi. 5 Thus, providing a method that determines whether to ligate or to preserve and reconstruct certain arteries is desirable.…”

Section: Introductionmentioning

confidence: 99%

“…However, the feasibility of this method remains controversial, and some studies have demonstrated that intentional transection of small accessory arteries unexpectedly leads to massive loss of blood supply. 5 Thus, the “2-mm cutoff” value of diameter is obviously not an accurate method for the assessment of blood supply. Another method was reported by Troppmann C, where multiple arteries supplying less than 10% of the total blood volume, were suggested to be ligated.…”

Section: Introductionmentioning

confidence: 99%

Methylene blue usage for determining accessory artery ligation in donor kidneys

Li¹,

Song²,

Hu³

et al. 2020

Surg Innov

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Objectives. We present a technique for determining whether to ligate or preserve accessory arteries in donor kidneys before implantation. Methods. Forty-three living-related donor kidneys in patients from January 2014 to February 2018 at our institution were included, all of which had dual arteries without the same stem. Among them, 19 cases of accessory arterial blood supply were evaluated using methylene blue (MB) perfusion, and accessory arteries supplying less than 10% of the total MB perfusion volume were ligated. The other 24 cases were assessed using a conventional method in which arteries with diameters less than 2 mm were ligated. The back-table surgical time, Doppler ultrasonography index, renal function and complications were compared between the 2 groups. Results. All patients underwent successful kidney transplantation. The back-table surgical time in the MB group was longer than that in the conventional group (42.70 ± 4.70 min vs 34.64 ± 5.30 min, P < .05). The serum creatinine level in the MB group was significantly lower than that in the conventional group 1 month after the operation (103.15 ± 19.26 μmol/L vs 119.17 ± 28.32 μmol/L, P < .05). No differences in the Doppler ultrasonography index or postoperative complications were noted. Conclusions. MB perfusion provides an easy and effective method to make decisions regarding arterial ligation and helps preserve renal function without increasing the number of complications after transplantation.

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