Outcome of living kidney donors left with multiple renal arteries

Abstract

Individuals with kidneys having ≥2 arteries appear to have an increased incidence of hypertension. Whether kidney donors in whom the remaining kidney has ≥2 arteries are at increased risk of hypertension is unknown. Therefore, we studied 3685 kidney donors to determine whether donors left with a kidney having ≥2 arteries were at increased risk of hypertension, impaired renal function, or death. Cohorts were assigned based on our practice pattern and the anatomy of the donated kidney. Of the 3685 donors, 1211 were estimated to have a remaining kidney with ≥2 arteries. Mean follow-up time for the single-artery group was 14.1 (±11.0) yr and 15.3 (±11.2) yr for the ≥2 artery group. Six-month hospital readmission rate was 1.4% and 1.2%, hypertension was noted in 22.4% and 21.8% and proteinuria in 9.7% and 9.6%, and estimated glomerular filtration rate at last follow-up was 62 (±28) and 62 (±16) for single vs. ≥2 renal artery groups, respectively. Our data suggest no adverse clinical sequelae nor any decrease in long-term survival for donors left with a kidney having ≥2 renal arteries.

Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries

“…In surgical terms, the upper pole artery represents a major risk, because it is frequently located high up the kidney, meaning that in most cases the surgeons may mistake it for surrounding connective tissue and unknowingly cut through it, thereby causing massive bleeding, which most often leads to a fatal outcome [ 5 ]. Furthermore, Rizzari et al [ 100 ] note that individuals with kidneys with 2 or more arteries appear to have an increased incidence of hypertension.…”

Clinical importance of anatomical variations of renal vasculature during laparoscopic donor nephrectomy

“…These variations can lead to significant surgical complications or even lifethreatening events if unrecognised. There are increased reports in the literature identifying variation of renal vasculature during live donor nephrectomy [1][2][3][4][5][6][7][8][9][10][11] . Undoubtedly, a thorough knowledge in understanding of the embryologic development and associated anatomy of renal vessel variations will equip the surgeons to anticipate and manage these potential risks successfully to prevent the complications.…”

Age alone is not a contraindication to kidney donation: Outcomes of donor nephrectomy in the elderly

“…9,10 To verify the presence of 2 functional kidneys and assess vascular anatomy, we used angiography, high-resolution computed tomographic angiography, or magnetic resonance angiography. Similar to global trends, as our experience with LDK expanded, we began approving >60-years-old with increasing frequency in an effort to fill the growing imbalance between transplantable organs and waitlist candidates.…”

“…Our living donor evaluation criteria have previously been described. 9,10 To verify the presence of 2 functional kidneys and assess vascular anatomy, we used angiography, high-resolution computed tomographic angiography, or magnetic resonance angiography. If we found a large size discrepancy between the 2 kidneys, we obtained a split-function renogram to individually assess the functional status of each kidney.…”