title: Successful renovascular reconstruction for renal allografts with multiple renal arteries.
abstract: BACKGROUND
  Kidney grafts with multiple renal arteries have been considered a relative contraindication because of the increased risk of complications. In the present study, we retrospectively reviewed multiple renal artery reconstruction in kidney transplantation to elucidate the usefulness of these grafts.
  
  
  METHODS
  From January 1997 until August 2001, 431 recipients underwent kidney transplantation at our institution; 393 patients are reviewed. The surgical techniques of vascular reconstruction and short-term outcome are reported. The living kidney transplant recipients were divided into vascular reconstructed and nonreconstructed groups, and mean serum creatine levels, warm and total ischemic times, and incidences of acute rejection and posttransplantation hypertension were compared.
  
  
  RESULTS
  We noted multiple renal arteries in 96 (24.4%) of the 393 grafts. Arterial reconstruction was performed on 53 (13.5%) grafts, whereas 43 (10.9%) small polar arteries were simply ligated. Surgical management of the multiple arteries was variable. The most common reconstruction was conjoined anastomosis (17 cases) between two arteries of equal size and end-to-side anastomosis (14 cases) of smaller arteries to larger arteries. In nine cases, autogenous hypogastric or epigastric artery grafts were used to reconstruct multiple renal arteries. Multiple anastomosis was performed in six cases. In seven cases, complicated surgical vascular reconstruction was performed. The mean total ischemic times in the reconstructed and nonreconstructed groups were 102.6 and 71.0 min, respectively (P<0.01). The incidences of posttransplantation hypertension in the reconstructed and nonreconstructed groups were 68.2% (30/44) and 48.6% (141/290), respectively (P<0.05). There was no significant difference between the reconstructed and nonreconstructed groups in mean warm ischemic times, mean creatinine levels, and incidences of acute rejection.
  
  
  CONCLUSIONS
  Allografts with multiple renal arteries can be used successfully in kidney transplantation.
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. makiya@venus.dti.ne.jp.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Makiyama
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishida
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Tokumoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimmura
authors.forename: Kazuya
authors.initials: K
authors.lastname: Omoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Toma
mesh_terms: D000208:Acute Disease; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006801:Humans; D006977:Hypertension, Renal / Q000401:mortality; D015994:Incidence; D007511:Ischemia / Q000401:mortality; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D011183:Postoperative Complications / Q000401:mortality*; D019651:Plastic Surgery Procedures / Q000379:methods; D012077:Renal Artery / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D003404:Creatinine