title: The new technique of using the epigastric arteries in renal transplantation with multiple renal arteries.
abstract: The most common anatomic variant seen in the donor kidneys for renal transplantation is multiple renal arteries (MRA), which can cause an increased risk of complications. We describe the long-term outcomes of 16 years of experience in 76 kidney transplantations with MRAs. In a new reconstruction technique, we remove arterial clamps after anastomosing the donor to the recipient's main renal vessels, which cause backflow from accessory arteries to prevent thrombosis. By this technique, we reduce the ischemic times as well as the operating times. Both in live or cadaver donor kidneys, lower polar arteries were anastomosed to the inferior epigastric artery and upper polar arteries were anastomosed to the superior epigastric arteries. Injection of Papaverine and ablation of sympathic nerves of these arteries dilate and prevent them from post-operative spasm. Follow-up DTPA renal scan in all patients showed good perfusion and function of the transplanted kidney, except two cases of polar arterial thrombosis. Mean creatinine levels during at least two years of follow-up remained acceptable. Patient and graft survival were excellent. No cases of ATN, hypertension, rejection and urologic complications were found. In conclusion, this technique can be safely and successfully utilized for renal transplantation with kidneys having MRAs, and may be associated with a lower complication rate and better graft function compared with the existing techniques.
authors.affiliation: Department of Urology, Hamadan University of Medical Sciences, Hamadan, Iran. dr_amirzargar@yahoo.com
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Amirzargar
authors.forename: Hooshang
authors.initials: H
authors.lastname: Babolhavaeji
authors.forename: Shahriar Amir
authors.initials: SA
authors.lastname: Hosseini
authors.forename: Habibmousavi
authors.initials: H
authors.lastname: Bahar
authors.forename: Mahmood
authors.initials: M
authors.lastname: Gholyaf
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Dadras
authors.forename: Farhad
authors.initials: F
authors.lastname: Khoshjoo
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Yavangi
authors.forename: Nasibeh
authors.initials: N
authors.lastname: Amirzargar
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D046148:Donor Selection; D019074:Epigastric Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012077:Renal Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016284:Technetium Tc 99m Pentetate; D013997:Time Factors; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications*; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate