title: Renal vein extension during living-donor kidney transplantation in the era of hand-assisted laparoscopic living-donor nephrectomy.
abstract: BACKGROUND
  To evaluate retrospectively the clinical outcomes of living-donor kidney transplantations (LDKTs) using renal vein extension (RVE) for donor kidneys with short renal veins.
  
  
  METHODS
  Between January 2007 and December 2010, a total of 576 LDKTs were performed with grafts generated by hand-assisted laparoscopic living-donor nephrectomy: 31 (5.4%) transplants with RVE and 545 (94.6%) without an additional vascular procedure for renal vein lengthening. Outcomes were compared in patients who did and did not undergo the RVE procedure during transplantation.
  
  
  RESULTS
  The 31 transplantation patients that underwent RVE involved procured kidneys with short renal veins: 29 were right-sided kidneys (93.5%) and 2 were left-sided kidneys (6.5%) (P=0.00). The RVE grafts were obtained from allogenic gonadal veins from female donors (n=16, 51.6%) and iliac veins from deceased donors (n=15, 48.4%). There were no postoperative complications related to the RVE procedure. During a follow-up period of 45.6±15.9 months, there were one (3.2%) graft failure among the 31 patients with RVE and four (0.7%) among the 545 patients without RVE. Delayed graft function was noted in one (3.2%) of the RVE patients and 22 (4.0%) of the patients without RVE. There was no statistically significant difference in graft failure (P=0.24) or delayed graft function (P=1.00) between the two groups.
  
  
  CONCLUSIONS
  During LDKT, donor kidneys with exceptionally short renal veins, which may result in unavoidable tension during renal vein anastomosis, may be modified by RVE, thus facilitating a secure anastomosis and reducing postoperative complications.
authors.affiliation: 1 Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. 2 Department of Surgery, Pusan National University School of Medicine and Medical Research Institute, Pusan, Korea.
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
authors.forename: Youngjin
authors.initials: Y
authors.lastname: Han
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Ki Byung
authors.initials: KB
authors.lastname: Song
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Chung
authors.forename: Byung Hyun
authors.initials: BH
authors.lastname: Choi
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kwon
authors.forename: Yong-Pil
authors.initials: YP
authors.lastname: Cho
mesh_terms: D000328:Adult; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006085:Graft Survival; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010053:Ovary / Q000098:blood supply*; D012082:Renal Veins / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome