Laparoscopic procurement of kidneys with multiple renal arteries is associated with increased ureteral complications in the recipient.
This study investigates the effect of renal artery multiplicity on donor and recipient outcomes after laparoscopic donor nephrectomy. Three-hundred and sixty-one sequential procedures were performed over a 4-year period. Forty-nine involved accessory renal arteries; of these, 36 required revascularization and 13 were small polar vessels and ligated. The 312 remaining kidneys with single arteries served as controls. Study variables included operative times, blood loss, hospital stay, graft function and donor and recipient complications. Kidneys with multiple revascularized arteries had a longer mean warm ischemia time (35.3 vs. 29.2 min, p = 0.0003), and more ureteral complications (6/36 vs. 10/312, p = 0.0013) than single-artery controls. In contrast, ligation of a small superior accessory artery had no significant effect on donor operative time, blood loss, or complication rate while providing similar recipient graft function compared to single-artery controls. Renal artery number is important in selecting the appropriate kidney for laparoscopic procurement. Given the current excellent results with right-sided donor nephrectomy, kidneys with single arteries should be preferentially procured, irrespective of side.
Carter
Jonathan T
JT
Division of Transplantation Surgery, University of California - San Francisco, USA.
Freise
Chris E
CE
McTaggart
Ryan A
RA
Mahanty
Harish D
HD
Kang
Sang-Mo
SM
Chan
Sharon H
SH
Feng
Sandy
S
Roberts
John P
JP
Posselt
Andrew M
AM
D000328:Adult; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D012077:Renal Artery / Q000002:abnormalities* / Q000601:surgery; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery