title: Vascular challenges in renal transplantation.
abstract: BACKGROUND
  The increasing demand for transplantable organs, especially kidneys, has led to expanded criteria for renal transplant donors. As a result of the expanded criteria, more organs with vascular anomalies and/or pathologies are available for transplant. This retrospective study evaluated the impact of vascular repair on the outcome in kidney transplantation in a single center over a 15-year period.
  
  
  METHODS
  Between January 1997 and May 2012, 1134 deceased donor renal transplantations were performed in the Department for Vascular and Endovascular Surgery of the University of Düsseldorf, Germany.
  
  
  RESULTS
  A vascular reconstruction of some type was necessary to repair renal vessels or to prepare the recipient site for transplantation in 374 of 1134 (33.0%) renal transplantations. The iliac artery in 12.3% (139/1134) of cases and the renal artery in 10.1% (115/1134) of cases showed severe atherosclerosis and a thrombo-endarterectomy was required. Organ loss occurred in 13 cases (1.1%) due to vascular failure. The 5-year graft survival for kidneys with reconstructed renal arteries was 84.3% in deceased donor renal transplantations (86.1% without arterial reconstruction).
  
  
  CONCLUSIONS
  The demand for renal transplants has led to more marginal-quality organs and older donors and/or recipients waiting for a second or third transplantation. Thus, the expertise of a vascular surgeon is extremely helpful in a transplantation center because it allows for marginal organ transplantation with acceptable 5-year graft survival rates.
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Tolga Atilla
authors.initials: TA
authors.lastname: Sagban
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Baur
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Schelzig
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Grabitz
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Mansur
authors.initials: M
authors.lastname: Duran
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000473:pathology / Q000601:surgery; D046148:Donor Selection; D004691:Endarterectomy; D005260:Female; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery; D007668:Kidney / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012077:Renal Artery / Q000473:pathology / Q000601:surgery; D012082:Renal Veins / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting