title: Vascular Multiplicity Should Not Be a Contra-Indication for Live Kidney Donation and Transplantation.
abstract: BACKGROUND
  Whether vascular multiplicity should be considered as contraindication and therefore 'extended donor criterion' is still under debate.
  
  
  METHODS
  Data from all live kidney donors from 2006-2013 (n = 951) was retrospectively reviewed. Vascular anatomy as imaged by MRA, CTA or other modalities was compared with intraoperative findings. Furthermore, the influence of vascular multiplicity on outcome of donors and recipients was studied.
  
  
  RESULTS
  In 237 out of 951 donors (25%), vascular multiplicity was present. CTA had the highest accuracy levels regarding vascular anatomy assessment. Regarding outcome of donors with vascular multiplicity, warm ischemia time (WIT) and skin-to-skin time were significantly longer if arterial multiplicity (AM) was present (5.1 vs. 4.0 mins and 202 vs. 178 mins). Skin-to-skin time was significantly longer, and complication rates were higher in donors with venous multiplicity (203 vs. 180 mins and 17.2% vs. 8.4%). Outcome of renal transplant recipients showed a significantly increased WIT (30 vs. 26.7 minutes), higher rate of DGF (13.9% vs. 6.9%) and lower rate of BPAR (6.9% vs. 13.9%) in patients receiving a kidney with AM compared to kidneys with singular anatomy.
  
  
  CONCLUSIONS
  We conclude that vascular multiplicity should not be a contra-indication, since it has little impact on clinical outcome in the donor as well as in renal transplant recipients.
authors.affiliation: Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jeffrey A
authors.identifier: http://orcid.org/0000-0002-2727-0524
authors.initials: JA
authors.lastname: Lafranca
authors.affiliation: Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: van Bruggen
authors.affiliation: Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Hendrikus J A N
authors.initials: HJ
authors.lastname: Kimenai
authors.affiliation: Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Thi C K
authors.initials: TC
authors.lastname: Tran
authors.affiliation: Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Türkan
authors.initials: T
authors.lastname: Terkivatan
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Michiel G H
authors.initials: MG
authors.lastname: Betjes
authors.affiliation: Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jan N M
authors.initials: JN
authors.lastname: IJzermans
authors.affiliation: Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Frank J M F
authors.initials: FJ
authors.lastname: Dor
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation; D019520:Living Donors; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000033:anatomy & histology; D012082:Renal Veins / Q000033:anatomy & histology*; D012189:Retrospective Studies; D052096:Warm Ischemia