title: Revascularization of living-donor kidney transplant with multiple arteries: long-term outcomes using the inferior epigastric artery.
abstract: OBJECTIVE
  To study the safety and long-term outcomes of use of the inferior epigastric artery (IEA) for revascularization of small accessory kidney arteries (3 mm or less).
  
  
  METHODS
  Data of 602 living-donor kidney transplants were reviewed. Age was 37.4 ± 15 years (range, 3-78 years). Multiple arteries were present in 98 kidneys (16.3%); of these, 83 (84.7%) had 2 and arteries and 15 (15.3%) had 3 arteries. In 21 kidneys (21.4%) with multiple arteries (group I [GI]), the IEA was used for reconstruction. Four (14.3%) had 3 arteries, and 17 (85.7%) had 2 arteries. In 77 patients (group II [GII]), the inferior accessory renal artery was reconstructed with a side-to-side or an end-to-side anastomosis to the main renal artery. Follow-up was 43.8 ± 38.1 months (range, 1-124 months). The Fisher exact test and the 2-tailed t test were used for statistical analysis.
  
  
  RESULTS
  Delayed graft function occurred in 1 GI patient (4.8%) and in 5 GII patients (6.5%; P >.05). One partial renal infarction occurred in each group (4.8% vs 1.3%; P >.05). There was 1 urinary fistula in GI and 3 urinary fistulas and 1 ureteral stenosis in GII (P >.05). One graft (4.8%) lost function in GI and 5 (6.5%) in GII (P >.05). Eleven patients (53.4%) were hypertensive in GI and 53 (68.8%) in GII (P >.05).
  
  
  CONCLUSIONS
  The use of the IEA for revascularization of a living-donor kidney transplant with multiple arteries is safe and effective, yielding similar long-term outcomes compared with the standard technique. Use of the IEA avoids the risks of manipulation of the main renal artery.
authors.affiliation: Division of Urology, Renal Transplantation Unit, University of São Paulo Medical School, São Paulo, SP, Brazil.
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Antonopoulos
authors.affiliation: Division of Urology, Renal Transplantation Unit, University of São Paulo Medical School, São Paulo, SP, Brazil. Electronic address: kleiton_med91@yahoo.com.br.
authors.forename: Kleiton Gabriel Ribeiro
authors.initials: KG
authors.lastname: Yamaçake
authors.affiliation: Division of Urology, Renal Transplantation Unit, University of São Paulo Medical School, São Paulo, SP, Brazil.
authors.forename: Lorena M
authors.initials: LM
authors.lastname: Oliveira
authors.affiliation: Division of Urology, Renal Transplantation Unit, University of São Paulo Medical School, São Paulo, SP, Brazil.
authors.forename: Affonso C
authors.initials: AC
authors.lastname: Piovesan
authors.affiliation: Division of Urology, Renal Transplantation Unit, University of São Paulo Medical School, São Paulo, SP, Brazil.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kanashiro
authors.affiliation: Division of Urology, Renal Transplantation Unit, University of São Paulo Medical School, São Paulo, SP, Brazil.
authors.forename: Willian C
authors.initials: WC
authors.lastname: Nahas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019074:Epigastric Arteries / Q000637:transplantation*; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting; D055815:Young Adult