title: Evaluation of the Vascular Surgical Complications of Renal Transplantation.
abstract: BACKGROUND
  Renal transplantation is the treatment of choice of end-stage renal failure. However, vascular surgical complications can compromise the functional prognosis of the transplant or even be life threatening in the short term. Since few data are available in the literature, the objective of this study was to evaluate the vascular surgical complications of renal transplantation.
  
  
  METHODS
  In a retrospective and monocentric study, the records of all the patients receiving a kidney transplant between January 2008 and December 2014 were reviewed. The demographic data and the follow-up of the patients who presented a vascular surgical complication in relation to their transplant were collected. Minor, intermediate, or major vascular complications were defined according to the need for monitoring, reoperation, or the risk of transplant loss or a life-threatening situation. Predictive factors of vascular complications were also looked for.
  
  
  RESULTS
  Mean age was 50.9 ± 15.0 years, and 312 kidney transplants were carried out (205 men). Fifty vascular surgical complications (16.0%) were found. Among them, 23 vascular complications (7.4%) were major, including 6 (1.9%) which required transplantectomy, after 4 arterial thromboses (1.3%), 1 early venous thrombosis (0.3%), and 1 injury of the inferior vena cava (0.3%). Twelve complications (3.8%) were minor. Surgical revision was necessary in 76% of the vascular complications (n = 38). The average follow-up of the transplanted population was 37.4 ± 24.0 month, 268 kidney transplants (85.8%) were functional and 21 patients (6.7%) returned to dialysis. Surgical complications were more frequent when the recipient had hypertension (P = 0.02, OR = 2.5; 95% CI [1.1-6.1]), in case of right kidney transplant (P = 0.0004, OR = 3.1; 95% CI [1.6-5.8]) and when the kidney hilum consisted of at least arteries (P = 0.02, OR = 10.0; 95% CI [1.3-34]). Male gender (P = 0.03, OR = 0.5; 95% CI [0.3-0.9]) as well as the choice of the common iliac arterial (P = 0.001, OR = 0.4; 95% IC [0.2-0.7]) and venous (P = 0.002, OR = 0.3; 95% IC [0.2-0.8]) axes to carry out the vascular anastomoses appeared as protective factors.
  
  
  CONCLUSIONS
  The vascular surgical complications of kidney transplantation, especially thromboses, can be serious and lead to transplant loss. The expertise of vascular surgeons finds its place here and makes it possible to maintain low rates of vascular complications and loss of transplants.
authors.affiliation: Service de chirurgie vasculaire, CHU d'Angers, Angers, France; Université de Médecine d'Angers, Angers, France. Electronic address: ammimyriam@yahoo.fr.
authors.forename: Myriam
authors.initials: M
authors.lastname: Ammi
authors.affiliation: Service de chirurgie vasculaire, CHU d'Angers, Angers, France.
authors.forename: Mickael
authors.initials: M
authors.lastname: Daligault
authors.affiliation: Service de néphrologie, CHU d'Angers, Angers, France.
authors.forename: Jonnhy
authors.initials: J
authors.lastname: Sayegh
authors.affiliation: Université de Médecine d'Angers, Angers, France; Service d'explorations fonctionnelles vasculaires, CHU d'Angers, Angers, France; Laboratoire de biologie neurovasculaire et mitochondriale intégrée, UMR INSERM 1083, Angers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Abraham
authors.affiliation: Service de chirurgie vasculaire, CHU d'Angers, Angers, France; Université de Médecine d'Angers, Angers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Papon
authors.affiliation: Service de chirurgie vasculaire, CHU d'Angers, Angers, France; Université de Médecine d'Angers, Angers, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Enon
authors.affiliation: Service de chirurgie vasculaire, CHU d'Angers, Angers, France; Université de Médecine d'Angers, Angers, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Picquet
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005602:France; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*