Laparoscopic Procurement of Single Versus Multiple Artery Kidney Allografts: Is Long-Term Graft Survival Affected?

Abstract

Background Living donor kidneys with multiple arteries (MA) are increasingly procured laparoscopically for transplant. Methods We compare long-term graft function and survival of kidneys with single arteries (SA) and MA over a 10-year period. Results There were a total of 218 grafts with SA and 60 grafts with MA. The MA group had longer operative and ischemic times than SA group. There was a small increase in ureteral complication (8.3% vs. 2.3% P=0.06) and a significantly higher incidence of rejection (23.3% vs. 10.1%, P=0.01) in MA group than in SA group. Graft function was lower in MA group than SA group. The 5-year graft survival by Kaplan Meier analysis was better in SA group than in MA group (P=0.023). The estimated graft survivals at 1, 3, and 5 year were 94.4%, 90.6%, and 86% for SA group and 89.6%, 83.2%, and 71.8% for MA group. There was a higher percentage of graft loss from chronic allograft nephropathy in MA group than in SA group (16.7% vs. 5.5%, P=0.01). The presence of MA (vs. SA) was an independent risk for acute rejection (OR 3.60, 95% CI 1.59–8.14, P=0.002) and for graft loss (HR 2.31, 95% CI 1.05–5.09, P=0.038). Conclusion Laparoscopic procurement of living donor kidneys with SA may be associated with a lower risk of rejection, better function, and superior long-term survival when compared with kidneys with MA.

Early outcomes of laparoscopic donor nephrectomy with multiple renal arteries

“…In the other hand, Paramesh et al when analyzing 278 LDN during a 10-year period, showed in a multivariable logistic regression analysis that MA was an independent risk factor for acute rejection. The authors also showed that the graft function at 6 and 12 months was significantly lower in the MA group than SA group, and this trend persisted for 3 years after transplant (13). In the present study, the MA group had a higher rate of poor EGF when compared to the SA group (23% vs 12%, respectively).…”

“…Results from previous studies comparing renal function outcomes in patients with MA and SA have been variable (13,(16)(17)(18)(19)(20). Kuo et al. showed similar functional outcomes for patients with one, two or three renal arteries.…”

“…In patients with MA, there is an increased risk of injury from more extensive dissection (13). The requirement for complicated vascular reconstruction and more difficult anastomosis at the time of implantation impose additional ischemic injury and subsequent reperfusion injury (13). This extended dissection and the need for back-table reconstruction have been shown, by some authors, to be associated with an increased risk for urological and vascular complications (9,14,15).…”

“…However, this difference was not statistically significantly and was not associated with a higher recipient need for dialysis during the first postoperative week. In patients with MA, there is an increased risk of injury from more extensive dissection (13). The requirement for complicated vascular reconstruction and more difficult anastomosis at the time of implantation impose additional ischemic injury and subsequent reperfusion injury (13).…”

Techniques in laparoscopic donor nephrectomy

“…The presence of multiple renal arteries, however, results in higher rates of ureteric complications in the recipient compared with kidneys with a single artery (16.7% vs 3.2%, P = 0.001) [46]. In addition, transplantation of kidneys with multiple arteries has been shown to produce higher rates of graft loss than in organs with single vessels (HR 2.30, 95% CI 1.05, 5.09, P = 0.038) [47]. As ‘pure’ and hand‐assisted right LDN have been shown to be feasible and safe [48,49], with shorter operative times than left LDN [50], right LDN is now regarded as an acceptable alternative to left LDN in the presence of multiple renal arteries supplying the left kidney but not the right [51].…”