[Outcome of kidney transplants with multiple arteries].
OBJECTIVE
To evaluate the morbidity of multiple artery renal transplants (> 1 artery) and to assess the value of this parameter as a risk factor for complications of renal transplantation in adults.


METHODS
140 renal transplants derived from brain dead donors with multiple arteries (2 arteries = 123, 3 arteries = 17) were reviewed with a mean follow-up of 3 years (6-120 months). Pedicle restoration was performed in 57 cases (end-to-side reimplantation of a polar artery = 17, composite aortic patch graft = 14, multiple procedures = 10, ligation of a polar artery = 8, arterial wound = 5, "gun barrel" anastomosis of 2 arteries = 4). Arteriography was performed systematically in 57 cases, in the absence of any signs suggestive of a vascular complication.


RESULTS
2 recipients died from a vascular complication. 40% of transplants were functional at 5 years. 10 transplantectomies were performed for a vascular complication. 14 recipients returned to dialysis because of a vascular complication. 7.5% of systematic arteriographies revealed stenosis of the transplant artery. 54 transplants developed a vascular complication: thrombosis = 19, stenosis = 25. Three-artery transplants had a vascular morbidity of 50%. "Gun-barrel" anastomoses and polar reimplantations into the main trunk had a vascular morbidity of 40%. The urological morbidity was 10%.


CONCLUSIONS
Multiple artery renal transplants, especially 3-artery transplants and certain pedicle restorations, are associated with a high risk of vascular complications. Arterial anatomy is a selection criterion for the donor and recipient which must be taken into account in renal transplantation.
Lechevallier
E
E
Service d'Urologie et de Transplantation Rénale, Hôpital Salvator, Marseille.
Bretheau
D
D
Berland
Y
Y
Olmer
M
M
Rampal
M
M
Coulange
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007238:Infarction / Q000209:etiology; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation / Q000009:adverse effects / Q000000981:diagnostic imaging / Q000379:methods* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012078:Renal Artery Obstruction / Q000209:etiology; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology
Evolution des transplants rénaux à artères multiples.