title: Renovascular reconstruction of grafts with renal artery variations in living kidney transplantation.
abstract: BACKGROUND
  The shortage of grafts in living kidney transplantation has forced the use of marginal grafts with arterial disease or grafts with multiple renal arteries (MRA). We reviewed the outcomes of transplants using allografts with MRA procured by open donor nephrectomy and report two cases requiring vascular reconstruction.
  
  
  METHODS
  We reviewed 31 cases where renovascular reconstruction of an MRA graft was performed. A ex vivo pantaloon (side-to-side) anastomosis to create a common channel was performed in 24 cases including two cases of renal artery aneurysms in the grafts, where vascular reconstruction was performed in the same fashion after resection of the aneurysm. In four cases, an accessory artery was anastomosed sequentially after revasculization of the main artery. In three cases of grafts with multiple renal arteries, multiple anastomoses were done in situ after various ex vivo renovascular reconstructions.
  
  
  RESULTS
  Twenty one MRA grafts including grafts with a renal aneurysm are functioning well for a mean follow-up 135 months. The graft survival rate was 71.0% at 5 years after transplantation and 67.7% at 10 years. The donors whose grafts had a renal aneurysm were also well and normotensive with normal renal function at present. Ten grafts failed mainly due to chronic allograft nephropathy.
  
  
  CONCLUSIONS
  MRA grafts procured by open nephrectomy, including those with renal artery aneurysms, were engrafted successfully by applying appropriate renovascular surgery. The use of those grafts was safe for both the recipient and the donor.
authors.affiliation: Department of Transplantation and Regenerative Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan. kadotani@koto.kpu-m.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Kadotani
authors.forename: M
authors.initials: M
authors.lastname: Okamoto
authors.forename: K
authors.initials: K
authors.lastname: Akioka
authors.forename: H
authors.initials: H
authors.lastname: Ushigome
authors.forename: S
authors.initials: S
authors.lastname: Ogino
authors.forename: S
authors.initials: S
authors.lastname: Nobori
authors.forename: A
authors.initials: A
authors.lastname: Higuchi
authors.forename: Y
authors.initials: Y
authors.lastname: Wakabayashi
authors.forename: S
authors.initials: S
authors.lastname: Kaihara
authors.forename: N
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D000714:Anastomosis, Surgical; D000783:Aneurysm / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods / Q000473:pathology / Q000502:physiology*; D019520:Living Donors; D019651:Plastic Surgery Procedures; D012077:Renal Artery / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D012079:Renal Circulation; D012189:Retrospective Studies; D013997:Time Factors