Abstract. At the University of Pittsburgh during the calendar year 1986, an arterial injury occurred during harvesting in 20 (7.5%) of the 270 grafts used to perform kidney transplantation (KTx). Four cases required reconstruction, using extension iliac arterial allografts from cadaveric donors of the same blood type; 6 patients, remodelling of the aortic patch in multiple arteries; 4 cases, repairs for injuries to the smaller segmental/polar arteries; 6 cases, a combination of the above techniques. These ex vivo arterial reconstructions are described and the use of donor arterial homografts is emphasized. No deaths have occurred at an average follow-up of 19 months. The postoperative acute tubular necrosis (ATN) rate was significantly higher (90%) compared with non-reconstructed kidneys during the same year (30%). The 1-year graft survival of kidneys undergoing arterial reconstruction (75%) was statistically no different than the overall kidneytransplant survival. Whenever extension iliac allografts were utilized, the cyclosporin-steroid immunosuppression required to control the kidney rejection contributed to the long-term patency rate of the graft. Since the number of organs available for grafting is limited, reconstruction of injured renal vessels has become justified, allowing valuable kidneys to be used that would otherwise be lost.Key words: Arterial injury -Renal artery reconstruction -Kidney transplant.Kidney transplantation (KTx) has become the treatment of choice for end-stage renal disease. Because the number of organs available for grafting is Offprint requests to: T. E. Starzl limited, we have used kidneys that required simple or extensive vascular reconstruction in order to be transplantable. Previously, such organs had quite often been discarded. We report our own experience with reconstruction of the renal artery for cadaveric kidney transplantation, including the use of cadaveric iliac arterial grafts, during the calendar year 1986.
Materials and method
Case materialDuring 1986 at the University of Pittsburgh, 270 cadaveric renal transplantations were performed under cyc1osporin-steroid immunosuppression, to which OKT3 therapy was added when intractable rejection supervened. The blood now to the kidney was monitored postoperatively with a technetium renal scintigram. Twenty (7.5%) of the 270 grafts required arterial reconstruction. Eight of the grafts with arterial reconstruction were procured locally by our own surgeons; the other 12 were shipped in from other centers.Eighteen of the 20 donors were adults averaging 22 ± 15 (SO) years. Two pediatric donors were 6 and 8 years of age, respectively. Likewise, 18 of the 20 recipients were over 10 years old, averaging 30.4± 13 (SO) years; the only exceptions were two children 7 and 8 years of age, who received the two pediatric kidneys.
Source of vascular allograftsIliac artery and vein grafts are taken at the time of multiple organ harvesting [9,10], usually in continuity with the terminal aorta and inferior vena cava. The grafts are preserved in T...
