title: Anatomic variations in vascular and collecting systems of kidneys from deceased donors.
abstract: BACKGROUND
  Nephroureterectomy for transplantation has increased owing to the greater number of deceased donors. Anatomic variations may complicate the procedure or, if unrecognized, compromise the viability of kidneys for transplantation.
  
  
  METHODS
  We reviewed 254 surgical descriptions of nephroureterectomy specimens from January 2008 to December 2009. All organs collected according by standard techniques were evaluated for age, cause of death, renal function, frequency of injury during the procedure, as well as variations in the vascular and collecting systems.
  
  
  RESULTS
  The mean donor age was 42 years (range, 2-74). The mean serum creatinine was 1.2 mg/dL (range, 1.0-7.0). The causes of death were cerebrovascular cause (stroke; n = 130), traumatic brain injury (n = 81) or other cause (n = 43). Among the anatomic variations: 8.6% (n = 22) were right arterial anatomical variations: 19 cases with 2 arteries and 3 cases with 3 arteries. In 25 cases (9.8%) the identified variation was the left artery: 2 arteries (n = 23), 3 arteries (n = 1) and 4 arteries (n = 1). We observed 9.8% on right side and 1.5% on left side venous anatomic variations, including 24 cases with 2 veins on the right side and 4 cases with 2 veins on the left side. Three cases of a retroaortic left renal vein and 1 case of a retro necklace vein (anterior and posterior to the aorta). Two cases of ureteral duplication were noted on the left and 1 on the right kidney. There were 3 horseshoe and 1 pelvic kidney. In 7.5% of cases, an injury to the graft included ureteral (n = 3), arterial (n = 10), or venous (n = 6).
  
  
  CONCLUSIONS
  The most common anatomic variation was arterial (17.8%). Duplication of the renal vein was more frequent on the right. The high incidences of anatomic variations require more attention in the dissection of the renal hilum to avoid an injury that may compromise the graft.
authors.affiliation: Urology-Department of Surgery, Santa Casa de São Paulo, Serviço de Captação, Sao Paulo, Brazil. Hallison_castro@hotmail.com
authors.forename: H C
authors.initials: HC
authors.lastname: Costa
authors.forename: R J
authors.initials: RJ
authors.lastname: Moreira
authors.forename: P
authors.initials: P
authors.lastname: Fukunaga
authors.forename: R C
authors.initials: RC
authors.lastname: Fernandes
authors.forename: R C
authors.initials: RC
authors.lastname: Boni
authors.forename: A C
authors.initials: AC
authors.lastname: Matos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology* / Q000098:blood supply*; D007685:Kidney Tubules, Collecting / Q000033:anatomy & histology*; D008875:Middle Aged; D014019:Tissue Donors