title: Multiple Renal Arteries in Kidney Transplantation: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  The use of grafts with multiple renal arteries (MRA) in renal transplantation has not been clearly established.
  
  
  METHODS
  A systematic literature review used predefined terms to search PubMed, EMBASE, and the Cochrane Library for all studies since 1985 that included more than 50 MRA grafts. A total of 23 studies, comprising a total of 18,289 patients, were eligible to be included in the meta-analysis.
  
  
  RESULTS
  Patients who received an MRA graft compared to single renal artery (SRA) grafts showed significantly higher complication rates (13.8% vs. 11.0%, OR 1.393, p<0.0001), more delayed graft function (10.3% vs. 8.2%, OR 1.333, p=0.022), and had an associated significantly lower 1-year graft survival (93.2% vs. 94.5%, OR 0.819, p=0.034). Both the creatinine level and the warm ischemia time (WIT) were significantly higher in patients with MRA grafts but showed high heterogeneity (I² 98% for WIT and I² 70% for creatinine level). Although MRA grafts were associated with more complications compared to SRA grafts, long-term outcomes were similar for 5-year graft survival (81.4% vs. 81.6%) and 1- and 5-year patient survival (95.4% and 89.6% in MRA group vs. 95.4% and 87.0% in SRA group, respectively).
  
  
  CONCLUSIONS
  MRA grafts were associated with a higher risk of complication and delayed graft function but had comparable long-term outcomes for graft and patient survival.
authors.affiliation: Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: Zorgdrager
authors.affiliation: Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
authors.forename: Christina
authors.initials: C
authors.lastname: Krikke
authors.affiliation: Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
authors.forename: Sybrand H
authors.initials: SH
authors.lastname: Hofker
authors.affiliation: Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen,, Groningen, Netherlands.
authors.forename: Henri G D
authors.initials: HG
authors.lastname: Leuvenink
authors.affiliation: Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pol
mesh_terms: D051799:Delayed Graft Function / Q000209:etiology; D046148:Donor Selection / Q000379:methods*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012077:Renal Artery / Q000002:abnormalities* / Q000601:surgery; D016019:Survival Analysis; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome