title: Kidney transplantation in diabetic recipients with iliac atherosclerosis: arterial anastomosis with Nakayama's ring pin stapler after endarterectomy.
abstract: OBJECTIVE
  To report our experience of arterial anastomosis with Nakayama's ring pin staplers (titanium staplers) after an endarterectomy in kidney transplantation of diabetic recipients with iliac atherosclerosis.
  
  
  METHODS
  In a series of 2126 kidney transplantations carried out between January 1998 and December 2008, 62 recipients received an endarterectomy during transplantation before renal arterial anastomoses as a result of severe iliac atherosclerosis. The renal arteries were anatomosed to hypogastric arteries through titanium staplers in 32 patients (group 1), or to external/common iliac arteries with conventional suturing in 30 patients (group 2). Perioperative outcomes of the two groups have been compared.
  
  
  RESULTS
  The mean artery anastomosis time in group 1 was considerably shorter than in the group 2 (6.4 min vs 17.3 min, P < 0.001). Group 1 showed a lower rate of delayed graft function (4.8% vs 27.5%, P = 0.004). No difference in Kaplan-Meier patient survival rate was found between group 1 and group 2 after follow up of 67 ± 28 months (P = 0.58). Graft survival rate (patient deaths included) was higher in group 1 than in group 2 (P = 0.04).
  
  
  CONCLUSIONS
  Arterial anastomosis with a titanium stapler is more rapid than conventional suture. It can diminish the rate of delayed graft function and improve the graft survival rate in diabetic recipients with severe iliac atherosclerosis.
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Xiao-Peng
authors.initials: XP
authors.lastname: Yuan
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Jiao
authors.forename: Chang-Xi
authors.initials: CX
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D050197:Atherosclerosis / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D051799:Delayed Graft Function / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000601:surgery*; D004691:Endarterectomy / Q000295:instrumentation / Q000379:methods / Q000401:mortality*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000473:pathology / Q000601:surgery; D013528:Surgical Staplers; D016019:Survival Analysis; D014025:Titanium; D055815:Young Adult
chemical_list: D014025:Titanium