Multiple Renal Arteries in Kidney Transplantation: A Systematic Review and Meta-Analysis

Abstract

Self financing Background:The use of grafts with multiple renal arteries (MRA) in renal transplantation has not been clearly established. Material/Methods:A systematic literature review used predefined terms to search PubMed, EMBASE, and the Cochrane Library for all studies since 1985 that included more than 50 MRA grafts. A total of 23 studies, comprising a total of 18,289 patients, were eligible to be included in the meta-analysis. Results:Patients who received an MRA graft compared to single renal artery (SRA) grafts showed significantly higher complication rates (13.8% vs. 11.0%, OR 1.393, p<0.0001), more delayed graft function (10.3% vs. 8.2%, OR 1.333, p=0.022), and had an associated significantly lower 1-year graft survival (93.2% vs. 94.5%, OR 0.819, p=0.034). Both the creatinine level and the warm ischemia time (WIT) were significantly higher in patients with MRA grafts but showed high heterogeneity (I 2 98% for WIT and I 2 70% for creatinine level). Although MRA grafts were associated with more complications compared to SRA grafts, long-term outcomes were similar for 5-year graft survival (81.4% vs. 81.6%) and 1-and 5-year patient survival (95.4% and 89.6% in MRA group vs. 95.4% and 87.0% in SRA group, respectively). Conclusions:MRA grafts were associated with a higher risk of complication and delayed graft function but had comparable long-term outcomes for graft and patient survival.

Multiple Renal Arteries in Live Donor Renal Transplantation; Impact on Graft Function and Outcome: A Prospective Cohort Study

“…A systematic review and meta-analysis by Zorgdrager et al (2016) comparing outcomes of recipients receiving MRA grafts or grafts with SRA showed higher rates of complications and DGF, as well as lower 1-year graft survival among patients with grafts with MRA [4]. However, this study looked at studies that included primarily deceased donor transplants and their outcomes.…”

“…However, the increasing disparity between the escalating demand for renal transplantation and relatively stagnant supply of deceased donor organs has made it prohibitive for potential live donors to be declined based on arterial anatomy [2] [3]. Despite the technical difficulties and potential complications of transplanting donor kidneys with MRA, these organs are increasingly accepted to maximize the pool of acceptable donors [4]. With increasing expertise in vascular reconstruction and surgical tech- …”

Non‐standard criteria donors in pediatric kidney transplantation

“…A systematic review and meta‐analysis comparing patients who received an MRA graft compared to SRA graft showed significantly higher complication rates (13.8% vs 11.0%, OR 1.393, P < 0.0001), greater DGF (10.3% vs 8.2%, OR 1.333, P = 0.022), and a significantly lower 1‐year graft survival (93.2% vs 94.5%, OR 0.819, P = 0.034). Although MRA grafts were associated with more complications compared to SRA grafts, long‐term outcomes were similar for 5‐year graft survival (81.4% vs 81.6%) and 1‐ and 5‐year patient survival (95.4% and 89.6% in MRA group vs 95.4% and 87.0% in SRA group, respectively) …”

Correlation of preoperative imaging characteristics with donor outcomes and operative difficulty in laparoscopic donor nephrectomy

“…The number of arteries in the donated kidney is another variable which has been found to be an important factor, with Kok et al showing increased operating times of more than 20 minutes and increased recipient ureteral complications up to 47%, if lower pole arteries were present. A recent meta‐analysis showed a 13.8% complication rate in recipients of kidneys with multiple arteries, delayed graft function in 10.3% and graft survival of 93.2% compared to recipients of single‐artery kidneys with 94.5% ( P = .034) …”