title: Vascular constraints in laparoscopic renal allograft: comparative analysis of multiple and single renal arteries in 976 laparoscopic donor nephrectomies.
abstract: BACKGROUND
  Since the initial description of laparoscopic donor nephrectomy (LDN) in 1995, the field of renal transplantation has continued to evolve. Although the identification of donor kidneys with multiple renal arteries (MRA) was considered a contraindication to LDN, improvement in the surgical technique to surmount the technical challenges of LDN with MRA have been established as the skill and laparoscopic experience of transplant surgeons evolves with time. Consensus regarding LDN with MRA and recipient outcomes is not uniformly documented amongst the transplant community.
  
  
  METHODS
  A retrospective analysis of 976 patients who underwent LDN at our institution from January 1999 to August 2009 was performed. Patients were grouped based on the number of arteries and the data were compared with respect to patient demographics, operative characteristics, postoperative course and complications.
  
  
  RESULTS
  The two donor groups had comparable outcomes except for operative time, which was significantly prolonged in patients with MRA kidneys when compared to a single renal artery (SRA) kidney (P < 0.01). 1-, 3-year and estimated overall graft survival for the MRA recipient kidneys was significantly inferior when compared to SRA recipient kidneys.
  
  
  CONCLUSIONS
  Our decade long experience with LDN demonstrates that operative times for MRA kidneys are longer than for SRA kidneys, however complication rates are similar. Laparoscopic donor nephrectomy with MRA is a safe and effective procedure for living kidney donation; however, the recipient graft outcomes with MRA kidneys warrant appropriate preoperative counseling of recipients.
authors.affiliation: Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039, USA. prakashlalitha@yahoo.com
authors.forename: Prakash R
authors.initials: PR
authors.lastname: Paragi
authors.forename: Zachary
authors.initials: Z
authors.lastname: Klaassen
authors.forename: H Stephen
authors.initials: HS
authors.lastname: Fletcher
authors.forename: Matthew
authors.initials: M
authors.lastname: Tichauer
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Chamberlain
authors.forename: Jason R
authors.initials: JR
authors.lastname: Wellen
authors.forename: Harry
authors.initials: H
authors.lastname: Sun
authors.forename: Stuart
authors.initials: S
authors.lastname: Geffner
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000098:blood supply* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D012077:Renal Artery / Q000601:surgery*; D012079:Renal Circulation / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome