Fate of renal allografts connected to vascular prostheses.
OBJECTIVE
The outcome of renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is evaluated.


METHODS
All 7 Dutch transplant centers were invited to review their experience. Among a total of 5791 cadaveric renal transplantations performed between 1978 and 1994, 13 cases (0.2%) in 3 different centres were identified. In 6 cases the vascular reconstruction and transplant operation were performed simultaneously, and in 7 cases separately, with a mean interval of 3.5 yr. The indications for vascular reconstruction were aneurysmal disease in 4 and obstructive disease in 9 cases.


RESULTS
The early vascular complications of these procedures were hemorrhage in 4 and renal vein thrombosis in 1 and led to graft loss in 3 cases. The perioperative mortality was 2/13 (15%). The graft and patient survival were 68 and 83% respectively after 1 yr and 17 and 37% after 5 yr. Late mortality was mainly due to cardiovascular disease.


CONCLUSIONS
Renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is a hazardous procedure with relatively poor short- and long-term results. These observations should be considered in the choice of renal replacement therapy in this special patient population.
van der Vliet
J A
JA
Department of Surgery, University Hospitals, Nijmegen, The Netherlands.
Naafs
D B
DB
van Bockel
J H
JH
Kootstra
G
G
Boll
A P
AP
Barendregt
W B
WB
Buskens
F G
FG
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000783:Aneurysm / Q000601:surgery; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001807:Blood Vessel Prosthesis; D002102:Cadaver; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019106:Postoperative Hemorrhage / Q000209:etiology; D012082:Renal Veins; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology; D014184:Transplantation, Homologous; D016896:Treatment Outcome