Revascularization of Living-Donor Kidney Transplant With Multiple Arteries: Long-term Outcomes Using the Inferior Epigastric Artery

Antonopoulos, Ioannis; Yamaçake, Kleiton; Oliveira, Lorena Marçalo; Piovesan, Affonso; Kanashiro, Hideki; Nahas, Willian

doi:10.1016/j.urology.2014.06.022

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…Other applications ofvascular network culture could be fundamental studies of vascular development [14];recapitulating disease conditions such as the retinal microvascular abnormalities seen in diabetes [15]or the abnormal angiogenesis in tumor development [16]; testing anti-angiogenic compounds in cancer research [17] or candidate drugs for their safe clinical application [18]; and studies in vascular regenerative medicine [19] (Figure 1). It has long been known from the field of human and animal surgery, including transplant surgery, that tissue can become re-vascularized when grafted to a suitable site [20,21].…”

Section: Introductionmentioning

confidence: 99%

Beyond organoids: In vitro vasculogenesis and angiogenesis using cells from mammals and zebrafish

Ibrahim

Richardson

2017

Reproductive Toxicology

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The ability to culture complex organs is currently an important goal in biomedical research. It is possible to grow organoids (3D organ-like structures) in vitro; however, a major limitation of organoids, and other 3D culture systems, is the lack of a vascular network. Protocols developed for establishing in vitro vascular networks typically use human or rodent cells. A major technical challenge is the culture of functional (perfused) networks. In this rapidly advancing field, some microfluidic devices are now getting close to the goal of an artificially perfused vascular network. Another development is the emergence of the zebrafish as a complementary model to mammals. In this review, we discuss the culture of endothelial cells and vascular networks from mammalian cells, and examine the prospects for using zebrafish cells for this objective. We also look into the future and consider how vascular networks in vitro might be successfully perfused using microfluidic technology.

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Section: Introductionmentioning

confidence: 99%

Beyond organoids: In vitro vasculogenesis and angiogenesis using cells from mammals and zebrafish

Ibrahim

Richardson

2017

Reproductive Toxicology

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“…Separate implantation of smaller artery in external or internal iliac artery runs the risk of prolonging the WIR potentially leading to worse graft outcomes. [ 13 ] Although sequential anastomosis of the smaller artery with the inferior epigastric artery is another good option described earlier by the senior author,[ 4 ] the inferior epigastric artery may not always be available due to atherosclerosis or insufficient diameter relative to the accessory renal artery. [ 5 ] The smaller renal artery may also be prone to thrombosis or stenosis.…”

Section: Discussionmentioning

confidence: 99%

Management of donor kidneys with double renal arteries with significant luminal discrepancy: A retrospective cohort study

et al. 2020

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Introduction: Side-to-side pantaloon anastomosis for renal grafts with double renal arteries (RA) with significant luminal discrepancy between graft arteries has not been reported. We hypothesized that the pantaloon technique is feasible and safe in these cases. Materials and Methods: A retrospective review of all consecutive, open, live-related renal transplants with double RA with significant luminal discrepancy performed at our center from January 2014 to September 2018 was undertaken. Significant luminal discrepancy was defined as smaller RA constituting 30% ± 5% of total RA diameter on preoperative computed tomography angiogram. Three groups were defined: Group A - pantaloon anastomosis, Group B - end-to-side anastomosis of smaller to main RA, and Group C - separate implantation of each artery. The primary objective was to study feasibility and safety of pantaloon anastomosis measured by recipient serum creatinine levels, Doppler ultrasound, and vascular complications (vascular thrombosis and anastomotic bleed). Secondary objectives included measurement of cold ischemia time, warm ischemia time in recipient (WIR), and nonvascular recipient complications. Results: Fifty-eight recipients had donors with double RA with significant luminal discrepancy. Group A - included 40, Group B – 5, and Group C - 13 patients. Recipient creatinine at day-7, - 30, and - 90 were similar among the groups. The 30-day perioperative complication rate was also similar. Group A and B had significantly lower WIR and higher cold ischemia time compared to Group C. Conclusion: Pantaloon anastomosis is feasible in renal grafts with double RA with significant luminal discrepancy and offers advantage of lower WIR compared to separate implantation technique.

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“…Both the inferior epigastric artery method and the direct anastomosis to recipient iliac artery appear to be good alternatives to the end-to-side method because long-term graft survival was similar to that in the control group. The inferior epigastric artery is often available and can be anastomosed after the main renal artery is reperfused, which contributes to reduced ischemia time and reduced incidence of delayed graft function [ 22 ]. However, the inferior epigastric artery is not always available because of atherosclerotic disease or insufficient size relative to the accessory renal artery [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Inferior long-term graft survival after end-to-side reconstruction for two renal arteries in living donor renal transplantation

et al. 2018

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Living donor kidneys with two arteries can be revascularized using various techniques depending on anatomy. We hypothesized that the revascularization technique could impact long-term outcomes. We retrospectively analyzed 1714 living donor renal transplants at our institution between 1999 and 2015. Three hundred and eleven kidneys had dual arteries, and these were categorized into 5 groups; end-to-side (n = 18), inferior epigastric artery (n = 21), direct anastomosis (n = 65), side-to-side (n = 126) and ligated (n = 81). We then compared the outcomes with that of a control group (single artery, n = 1403) using Kaplan-Meier and Cox regression analyses. Cox regression was adjusted by age, sex and race/ethnicity of donor and recipient, side of kidney, transplant period and recipient surgeon. Compared to the control group, the end-to-side group had increased all-cause graft loss (10 years: 77.2% vs 24.5%, adjusted hazard ratio [aHR] 3.02, 95% confidence interval [CI] 1.30–7.03, p = 0.010) and death-censored graft loss (10 years: 82.0% vs 55.9%, aHR 4.17, 95% CI 1.63–10.68, p = 0.003), whereas the other groups did not. Our study shows that 10-year overall survival and death-censored graft survival were significantly worse for end-to-side arterial reconstruction than for other techniques. Alternative techniques to the end-to-side method should be used for accessory arteries that require revascularization.

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Revascularization of Living-Donor Kidney Transplant With Multiple Arteries: Long-term Outcomes Using the Inferior Epigastric Artery

Cited by 14 publications

References 21 publications

Beyond organoids: In vitro vasculogenesis and angiogenesis using cells from mammals and zebrafish

Beyond organoids: In vitro vasculogenesis and angiogenesis using cells from mammals and zebrafish

Management of donor kidneys with double renal arteries with significant luminal discrepancy: A retrospective cohort study

Inferior long-term graft survival after end-to-side reconstruction for two renal arteries in living donor renal transplantation

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