title: Surgical prevention and management of vascular complications of kidney transplantation.
abstract: The main surgical changes in kidney procurement, preparation, and transplantation procedures occurred 20 years ago and were undertaken despite the inability to design randomized studies. The objective was to assess the evolution of vascular complications after kidney transplantation in a setting of surgical preventive measures in a historical series. A monocentric series of 3129 consecutive kidney transplantations performed over 3 decades was reviewed. The occurrence of arterial or venous thromboses, stenoses, and aneurysms was analyzed in relation with kidney procurement, preparation, and transplantation techniques. Vascular complications occurred in 13.5% of the recipients with a mean 3-year decrease in kidney graft function. The transplantation of a right kidney without renal vein extension, multiple renal arteries, ex vivo vascular repairs, and end-to-end arterial anastomoses were the unfavorable surgical vascular factors. It was possible to manage Transplant Renal Artery Stenosis (TRAS) nonsurgically in 80% of the cases. The prevention of vascular complications begins from the time of organ procurement by skilled surgeons. The aims of organ preparation are to evaluate the vascular risk, select the organs, and to simplify the anatomical constraints of vascular implantations. The three surgical steps of kidney transplantation are determinant in postoperative vascular complications and the duration of graft function.
authors: Urology department, University Hospital of Bicetre, Le Kremlin Bicetre, France  EA 4122, University Paris South, Le Kremlin Bicetre, France. thomas.bessede@gmail.com
authors: Thomas
authors: T
authors: Bessede
authors: Stephane
authors: S
authors: Droupy
authors: Yacine
authors: Y
authors: Hammoudi
authors: Dina
authors: D
authors: Bedretdinova
authors: Antoine
authors: A
authors: Durrbach
authors: Bernard
authors: B
authors: Charpentier
authors: Gerard
authors: G
authors: Benoit
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012077:Renal Artery / Q000473:pathology; D012078:Renal Artery Obstruction / Q000209:etiology / Q000517:prevention & control*; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*; D009927:Tissue and Organ Procurement