Does Kidney Transplantation with Multiple Arteries Affect Graft Survival?

Chabchoub, K.; Mhiri, Mohamed Nabil; Bahloul, Ali; Fakhfakh, S.; Hmida, I. Ben; Slimen, M. Hadj; Charfi, W.; Abdennader, M.; Frikha, Imed; Hachicha, J.

doi:10.1016/j.transproceed.2011.09.027

Cited by 22 publications

(13 citation statements)

References 3 publications

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“…[ 23 ] Some studies, however, have suggested higher recipient postoperative complication rates with MRA grafts. [ 2 3 4 5 6 7 8 9 ] When looking at laparoscopic living donor nephrectomy (LLDN), several studies have reported increased WIT, perhaps not unsurprising given the additional time taken for multiple arterial anastomoses. [ 3 5 6 14 28 ] Despite this, the additional WIT associated with MRA grafts results in comparable 1-year graft survival rates when compared to SRA grafts.…”

Section: Discussionmentioning

confidence: 99%

“…The only other significant difference that was noted in our cohort was increased estimated blood loss with MRA, although this has been commented on in other papers. [ 4 ] DGF, although not included in our study, is another variable that has been analyzed with MRA grafts procured by LLDN; some studies have demonstrated a higher incidence with MRA grafts although with no difference in graft survival at 1 year when compared to SRA grafts. [ 5 17 21 ] There has been some concern regarding vascular complications with MRA grafts, most commonly arterial stenosis and thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported increased incidences of warm ischemic time (WIT), delayed graft function (DGF), vascular and urological complications with MRA grafts. [ 2 3 4 5 6 7 8 9 ] Despite this, the current literature is still inconclusive and when comparing recipient outcomes from grafts with single renal arteries (SRA) and those with MRA, there does not appear to be a significant difference in long-term graft survival. [ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ] With up to 35% of donors having MRA, the ability to use these grafts for transplantation improves the donor pool greatly and helps to address transplant waiting times.…”

Section: Introductionmentioning

confidence: 99%

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Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels

et al. 2020

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Introduction: In kidney transplantation, total laparoscopic live donor nephrectomy (TLLDN) in the presence of multiple renal arteries (MRA) is technically challenging and has traditionally been associated with higher complication rates. We report our experience of using MRA grafts procured by TLLDN. Materials and Methods: Patients undergoing TLLDN at our center (2004–2014) was identified from a prospectively maintained database and divided into single renal arteries (SRA) or MRA groups. Recipient perioperative parameters, postoperative complications, and long-term graft survival were analyzed. Results: Of 465 patients, 106 had MRA and 359 had an SRA. There were six vascular complications in the SRA group and two in the MRA group (1.7% vs. 1.8%). There were eight ureteric complications requiring intervention in the SRA group compared to three in the MRA group (4% vs. 3%; P = 0.45). Acute rejection was observed in 12% of the SRA group compared to 9% in the MRA group ( P = 0.23). One-, 5- and 10-year graft survivals were 98.2%, 91.3%, and 89.8% in the MRA group versus 98.0%, 90.4%, and 77.5% in the SRA group (log-rank P = 0.13). Conclusion: The use of MRA grafts procured by TLLDN has comparable complication rates to SRA grafts and should not preclude selection for renal transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels

et al. 2020

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“…Variables that reflect the surgical complexity such as the number of renal arteries and veins [ 14 , 28 , 29 ], length of ureter and blood vessels [ 6 ], recipient BMI [ 30 – 32 ], and recipient age [ 33 ] as well as immunological parameters [ 16 , 17 ] and patient comorbidities [ 13 ] cannot be changed by the operating surgeon on the day of surgery. As soon as a donor kidney is allocated these preconditions are unchangeable.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that perioperative success or failure in kidney transplantation is related to donor organ quality [ 10 – 12 ], recipient comorbidities [ 13 ], quality of surgery [ 14 , 15 ], and immunological parameters [ 16 , 17 ] and that each of these categories contains hazards that can lead to one of the three major adverse events: (1) reoperation, (2) delayed graft function, or (3) graft loss. Furthermore, it is accepted that most of these hazards are unchangeable and elusive of control by the transplant surgeon at the time of scheduled surgery.…”

Section: Introductionmentioning

confidence: 99%

Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss

Emmanouilidis

Boeckler

Ringe

et al. 2017

Journal of Transplantation

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Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/>1h, ≤2h/>2h, ≤3h/>3h,…, ≤nh/>nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best R2 was identified. First and second derivative were then implemented into the curvature formula k(x) = f′′(x)/(1 + f′(x)2)3/2 to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern f(x) = A · (1 + k · e(I · x)) with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM–6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss.

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The accessory renal arteries: A systematic review with meta‐analysis

Triantafyllou,

Paschopoulos,

Węgiel

et al. 2024

Clinical Anatomy

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The accessory renal arteries (ARAs) are a well‐described variant of the renal vasculature with clinical implications for radiologists, surgeons, and clinicians. The aim of the present systematic review with meta‐analysis was to estimate the pooled prevalence of ARAs, including their variant number, origin, and termination, and to highlight symmetrical and asymmetrical morphological patterns. The systematic review used four online databases in accordance with PRISMA 2020 and Evidence‐based Anatomy Workgroup guidelines. R programming software was used for the statistical meta‐analysis. A total of 111 studies were considered eligible for our initial aim. The typical renal artery (RA) anatomy (a single bilateral vessel) was identified in 78.92%; the overall ARA prevalence was estimated at a pooled prevalence of 21.10%. The estimated pooled prevalence of one, two, three, and four ARAs were 18.67%, 1.80%, 0.01%, and <0.01%. The ARAs have been the subject of extensive research owing to their clinical importance, including in kidney transplantation surgery and resistant hypertension therapy. Knowledge of the typical and variant anatomy of RAs is essential for anatomists, radiologists, surgeons, and clinicians in order to avoid misunderstanding, complications, and iatrogenic injury.

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Does Kidney Transplantation with Multiple Arteries Affect Graft Survival?

Cited by 22 publications

References 3 publications

Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels

Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels

Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss

The accessory renal arteries: A systematic review with meta‐analysis

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