Renal allograft implantation in respect of atypical vascular procedures

Bašić, Dragoslav; Hadzi-Djokic, B Jovan; Milutinovic, D.; Basic, M; Djokic, R Milan

doi:10.2298/aci0304073b

Cited by 3 publications

(3 citation statements)

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“…Patients with iliac vascular pathology are known to have an increased risk of graft vascular complications including thrombosis (10% vs. 5% p = 0.04). The also have an increased risk of short‐ and long‐term mortality after kidney transplant compared to patients without vascular disease . One patient in this series had significant iliac atherosclerotic disease that led to poor perfusion of the renal graft and iliac artery dissection, necessitating graft removal and reconstruction of the iliac system and extension grafts from a third‐party deceased donor.…”

Section: Discussionmentioning

confidence: 96%

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Kidney clamp, perfuse, re‐implant: a useful technique for graft salvage after vascular complications during kidney transplantation

Mekeel

Halldorson

Berumen

et al. 2015

Clinical Transplantation

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Although intra-operative vascular complications during renal transplantation are rare, injuries associated with prolonged ischemia may lead to graft threatening early and late complications. This series describes a novel technique for intra-operative repair of vascular complications in five patients over a three-yr period. The method consists of rapid graft nephrectomy and re-preservation of the graft with cold University of Wisconsin solution, which allows for controlled/precise back table repair of the vascular injury without incurring prolonged warm ischemia time. In three cases, the donor renal vein (2) and donor renal artery (1) were damaged and required back table reconstruction. In two cases, the recipient iliac artery needed reconstruction. Three of the five cases used deceased donor iliac vessels from another donor for reconstruction. Two patients required postoperative dialysis for delayed graft function for three to nine d (average six d) and two patients had slow graft function. All grafts were functioning at 17 months (mean) after transplant, with a median serum of 1.61 mg/dL (0.74-3.69). This series demonstrates the effectiveness of kidney clamp, perfuse, resuscitate as an effective intra-operative technique to salvage grafts after vascular injury. Although the grafts may suffer from delayed or slow graft function, excellent long-term function is attainable.

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Section: Discussionmentioning

confidence: 96%

“…The use of extension grafts for short, multiple, or injured renal vessels has also been described . The extension grafts include recipient internal iliac artery , deceased donor vessels from the same or a third‐party donor , and polytetrafluoroethylene grafts .…”

Section: Discussionmentioning

confidence: 99%

Kidney clamp, perfuse, re‐implant: a useful technique for graft salvage after vascular complications during kidney transplantation

Mekeel

Halldorson

Berumen

et al. 2015

Clinical Transplantation

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“…The safety and outcomes of combining a revascularization procedure such as an endarterectomy, with renal transplant remains unclear. With the exception of case reports, and case series, there are very few research publications addressing this clinical question . Our transplant center is unique as we serve as a referral center for a large urban multiethnic metropolis, with a high prevalence of comorbidities such as morbid obesity, diabetes, cardiovascular, and peripheral vascular disease.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous recipient external iliac endarterectomy and renal transplant – a propensity score matched analysis

et al. 2019

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Summary Patients with end‐stage renal disease and severe iliac atherosclerosis are frequently denied renal transplant due to technical challenges, and risk of potential steal syndrome in the allograft, or ipsilateral limb. Few studies have evaluated the safety and efficacy of performing an endarterectomy in this setting. A single‐center retrospective review of renal transplant patients from 1/2013 to 12/2017 was performed. Patients requiring endarterectomy at the time of transplant were matched to a nonendarterectomized cohort in a 1:2 fashion using propensity score matching. Patients were followed for a minimum of 12 months. Simultaneous endarterectomy and renal transplant were performed in 23 patients and subsequently matched to 42 controls. Ankle‐brachial index was lower in the endarterectomized group (P = 0.04). Delayed graft function (26.1% vs. 19%, P = 0.54), graft loss (8.7% vs. 7.1%, P = 0.53), 1‐year mortality (8.7% vs. 4.8%, P = 0.53), and renal function at 12 months were comparable in both groups. There were no incidents of ipsilateral limb loss in the endarterectomized population. This is the first matched study investigating endarterectomy and renal transplant. Long‐term follow‐up of limb and graft function is indicated. Despite the small sample size, our findings suggest that a combined procedure can safely provide renal transplantation access to a previously underserved population.

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