Results of anastomosis of accessory lower polar graft artery to internal iliac artery in renal transplantation
Keywords:
Anastomosis, Lower polar graft artery, Iliac artery, Renal transplantationAbstract
Background: Our objective is to perform a renal graft transplant using multiple arteries where the lower polar artery will indeed be anastomosed to the internal iliac artery end to side following declamping the main arterial supply in terms of ischemia time, diuresis, graft perfusion, and postoperative clinical parameters and investigations. Methods: Fifty live donors underwent vascular anastomosis of the graft auxiliary lower polar artery to recipient internal iliac artery end to side anastomosis with various renal arteries bilaterally, including lower polar artery in chosen kidney. The recipients' intraoperative warm and total ischemia periods, as well as their postoperative incidence of acute tubular necrosis, were assessed (ATN). Diuresis, urinary output, and creatinine levels at 1, 3, and 5 days after surgery, as well as at 2 months afterwards. MRI and Doppler ultrasonography, if necessary. Results: In contrast to warm, the mean total ischemia time was 20.86 minutes. Low incidence of ATN (8%) was controlled and postoperative recovery went without a hitch. Regarding postoperative urine output and serum creatinine level monitoring, clinical and laboratory indicators were satisfactory. Depending on the assessment method, colour Doppler ultrasonography reveals well perfused transplanted grafts with a satisfactory peak systolic velocity ratio in the auxiliary graft artery.
Downloads
References
Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11:2093-109.
Pascual J, Zamora J, Pirsch JD. A systematic review of kidney transplantation from expanded criteria donors. Am J Kidney Dis. 2008;52:553-86.
Yuan H, Liu L, Zheng S, Yang L, Pu C, Wei Q, et al. The safety and efficacy of laparoscopic donor nephrectomy for renal transplantation: an updated meta-analysis. Transplant Proc. 2013;45:65-76.
Delmonico F. A Report of the Amsterdam Forum On the Care of the Live Kidney Donor: Data and Medical Guidelines. Transplantation. 2005;79:S53-66.
Kok NF, Dols LF, Hunink MG, Alwayn IP, Tran KT, Weimar W, et al. Complex vascular anatomy in live kidney donation: imaging and consequences for clinical outcome. Transplantation. 2008;85:1760-5.
Hu JC, Liu CH, Treat EG, Ernest A, Veale J, Carter S, et al. Determinants of laparoscopic donor nephrectomy outcomes. Eur Urol. 2014;65:659-64.
Kamali K, Abbasi MA, Ani A, Zargar MA, Shahrokh H. Renal transplantation in allografts with multiple versus single renal arteries. Saudi J Kidney Dis Transpl. 2012;23:246-50.
Cho HJ, Lee JY, Kim JC, Kim SW, Hwang TK, Hong SH. How safe and effective is routine left hand-assisted laparoscopic donor nephrectomy with multiple renal arteries? A high-volume, single-center experience. Transplant Proc. 2012;44:2913-7.
Paragi PR, Klaassen Z, Fletcher HS, Tichauer M, Chamberlain RS, Wellen JR, et al. Vascular constraints in laparoscopic renal allograft: comparative analysis of multiple and single renal arteries in 976 laparoscopic donor nephrectomies. World J Surg. 2011;35:2159-66.
Soliman SA, Shokeir AA, Kamal AI, El-Hefnawy AS, Harraz AM, Kamal MM, et al. Long-term outcome of grafts with multiple arteries in live-donor renal allotransplantation: Analysis of 2100 consecutive patients. Arab J Urol. 2011;9:171-7.
Hsu TH, Su L, Ratner LE, Trock BJ, Kavoussi LR. Impact of renal artery multiplicity on outcomes of renal donors and recipients in laparoscopic donor nephrectomy. Urology. 2003;61:323-7.
Oesterwitz H, Strobelt V, Blank W, Müller P. [Methods of extracorporeal renal artery reconstruction in cadaveric kidney allografts with special reference to microsurgery]. Z Urol Nephrol. 1985;78:433-45.
Roza AM, Perloff LJ, Naji A, Grossman RA, Barker CF. Living-related donors with bilateral multiple renal arteries. A twenty-year experience. Transplantation. 1989;47:397-9.
Kumar A, Gupta RS, Srivastava A, Bansal P. Sequential anastomosis of accessory renal artery to inferior epigastric artery in the management of multiple arteries in live related renal transplantation: a critical appraisal. Clin Transplant. 2001;15:131-5.
Horslen S, Barr ML, Christensen LL, et al: Pediatric transplantation in the United States, 1996–2005. Am J Transplant (2007) 7:1339–1358.
Butani L, Perez RV: Effect of pre-transplant dialysis modality and duration on long-term outcomes of children receiving renal transplants. Transplantation (2011) 91(4):447–451.
Hsu TH, Su Li, Ratner LE et al: Impact of renal artery multiplicity on outcomes of renal donors and recipients in laparoscopic donor nephrectomy. Urology,(2003); 61: 323–27
Oesterwitz H, Strobelt D, Scholz D, et al: extracorporeal microsurgical repair of injured multiple donor kidney arteries prior to cadaveric allotransplantation. EurUrol (1985) 11:100-105.
Hwang JK, Kim SD, Park SC et al: The long-term outcomes of transplantation of kidneys with multiple renal arteries. Transplant Proc, (2010); 42: 4053–57
Wolters HH, Schult M, Heidenreich S, et al The anastomosis between renal polar arteries and arterial epigastrica inferior in kidney transplantation: an option to decrease the risk of ureter necrosis? Transpl Int. (2001); 14 (6): 442-444.
Berardinelli L. Technical problems in living donor transplantation. Transplant Proc. (2005); 37 (6): 2449-2450.
Ghazanfar A, Tavakoli MR, Zaki R, Pararajasingam T, Campbell NR, Parrott et al. The outcomes of living donor renal transplants with multiple renal arteries: a large cohort study with a mean follow-up period of 10 years transplantation proceedings. (2010); 42 (5): 1654-1658.
Konomi K, Matsuo K, Kayashima K et al. Use of inferior epigastric artery for reconstruction of a small accessory artery in renal transplantation. SurgGynaecObst (1990): 171: 417-8.
El-Sherbiny M, Abou-Elela A, Morsy A, Salah M, Foda A. The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation. IntUrolNephrol. (2008); 40 (2): 283-287.
Irshad A, Ackerman SJ, Campbell AS, Anis M An overview of renal transplantation: current practice and use of ultrasound. Semin Ultrasound CT MR (2009) 30(4):298–314
Beckmann J, Jackobs S, Klempnauer J Arterial Reconstruction in Kidney Transplantation. Transplantationsmedizin (2008) 20: 7-12
Akbar SA, Jafri SZ, Amen Faenza A, et al. Renal artery stenosis after renal trans-plantation. Kidney Int Suppl. (1983);14:S54–S59.
Fechner G, von Pezold C, Hauser S, et al: Impairment of long term graft function after kidney transplantation by intra operative vascular complications. IntUrolNephrol (2008) 40: 869-873
Zorgdrager M, Krikke C, Hofker SH,et al. Multiple renal arteries in kidney transplantation: a systematic review and meta-analysis. Ann Transplant 2016; 21: 469.
Lafranca JA, van Bruggen M, Kimenai HJ, et al. Vascular multiplicity should not be a contra-indication for live kidney donation and transplantation. PLos One 2016; 11
Roza AM, Perloff LJ, Naji A, et al. Living related donors with bilateral multiple renal arteries. A twenty year experience. Transplantation (1989);47:397–9.
Kadotani Y, Okamoto M, Akioka K, et al Management and Outcome of Living Kidney Grafts with Multiple Arteries Surg Today (2005) 35:459–466.
Tomić A, Milović N, Marjanović I, et al: Different techniques of vessel reconstruction during kidney transplantation. Vojnosanit Pregl (2015); 72(7): 614–618.
Beckmann J, Jackobs S, Klempnauer J Arterial Reconstruction in Kidney Transplantation. Transplantations medizin (2008) 20: 7-12
Akbar SA, Jafri SZ, Amen Faenza A, et al. Renal artery stenosis after renal trans-plantation. Kidney Int Suppl. (1983);14:S54–S59.
Fechner G, von Pezold C, Hauser S, et al: Impairment of long term graft function after kidney transplantation by intra operative vascular complications. IntUrolNephrol (2008) 40: 869-873
Marzouk, K., Lawen, J., Alwayn, I. &Kiberd, B. A. The impact of vascular anastomosis time on early kidney transplant outcomes. Transplantation research (2013) 2, 8.
Weissenbacher, A. Oberhuber R, Cardini B et al. The faster the better: anastomosis time influences patient survival after deceased donor kidney transplantation. Transplant international: official journal of the European Society for Organ Transplantation (2015) 28, 535–543.
Yin, M. Currin RT, Peng XX et al. Different patterns of renal cell killing after warm and cold ischemia. Ren Fail (2002) 24, 147–163.
Amirzargar M, Babolhavaeji H, Hosseini S et al The New Technique of Using the Epigastric Arteries in Renal Transplantation with Multiple Renal Arteries Saudi J Kidney Dis Transpl (2013);24(2):247-253.
Kadotani Y, Okamoto M, Akioka K, et al. Renovascular reconstruction of grafts with renal artery variations in living kidney transplantation. Transplant Proc. (2005);37(2):1049-51.
Szostek, M. Kosieradzki M, Chmura A, et al. Does “second warm ischemia time” play a role in kidney allograft function? Transplant Proc (1999) 31, 1037–1038.
McLaren, A. J Jassem W, Gray DW. et al. Delayed graft function: risk factors and the relative effects of early function and acute rejection on long-term survival in cadaveric renal transplantation. Clinical transplantation (1999) 13, 266–272.
Kyllonen, L. E. Salmela KT, Eklund BH et al. Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection. Transplant international: official journal of the European Society for Organ Transplantation (2000)13, 122–128.
Roodnat, J.I Mulder PG, Van Riemsdijk IC. et al. Ischemia times and donor serum creatinine in relation to renal graft failure. Transplantation (2003) 75, 799–804.
Szostek, M. Kosieradzki M, Chmura A, et al. Does “second warm ischemia time” play a role in kidney allograft function? Transplant Proc (1999) 31, 1037–1038.
Feuillu, B. Cormier L, Frimat L, et al. Kidney warming during transplantation. Transplant international: official journal of the European Society for Organ Transplantation (2003) 16, 307–312.
Halloran, P., Aprile, M. Factors influencing early renal function in cadaver kidney transplants. A case-control study. Transplantation (1988) 45, 122–127.
Tennankore, K. K., Kim, S. J., Alwayn, I. P. , Kiberd, B. A. Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantation. Kidney international (2016) 89, 648–658.
Heylen, L. Naesens M, Jochmans et al. The Effect of Anastomosis Time on Outcome in Recipients of Kidneys Donated After Brain Death: A Cohort Study. Am J Transplant(2015) 15(11), 2900–2907.
Weissenbacher, A. Oberhuber R, Cardini B et al. The faster the better: anastomosis time influences patient survival after deceased donor kidney transplantation. Transplant international: official journal of the European Society for Organ Transplantation (2015) 28, 535–543.
Kosmoliaptsis, V. Salji M, Bardsley V et al. Baseline donor chronic renal injury confers the same transplant survival disadvantage for DCD and DBD kidneys. Am J Transplant (2015) 15, 754–763.
Amirzargar M, Babolhavaeji H, Hosseini S et al The New Technique of Using the Epigastric Arteries in Renal Transplantation with Multiple Renal Arteries Saudi J Kidney Dis Transpl (2013);24(2):247-253.
Nashan B, Abbud-Filho M, Citterio F. Prediction, prevention, and management of delayed graft function: where are we now? Clin Transplant. (2016);30:1198-208.
Ardalan MR, Argani H, Mortazavi M, et al: More urine is better after renal transplantation. Transplant Proc (2003) 35:2612,
Knoll, E. and Stamm, D.: Specific determination of serum creatinine. Z KlinChemKlinBiochem, (1970) 8: 582,
Johnston O, O’kelly P, Spencer S et al. Reduced graft function (with or without dialysis) vs immediate graft -a comparison of long-term renal allograft survival. Nephrol Dial Transplant. 2006 Aug;21(8):2270-4.
Osman Y, Shokeir A, Ali-el-Dein B et al Vascular complications after live donor renal transplantation: study of risk factors and effects on graft and patient survival. J Urol. (2003);169(3):859-62.
Ghazanfar A, Tavakoli A, Augustine T et al:Management of transplant artery stenosis and its impact on long-term allograft survival: a single-centre experience. Nephrol Dial Transpl (2011) 26:336–343
Irshad A, Ackerman SJ, Campbell AS, Anis M An overview of renal transplantation: current practice and use of ultrasound. Semin Ultrasound CT MR (2009) 30(4):298–314
Patel NH, Jindal RM, Wilkin T, et al. Renal arterial stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology. (2001); 219 (3): 663-667.
Jing Gaoa, Jian-Chu Lib, Meng-Su Xiaob et al Color duplex sonography in severe transplant renal artery stenosis: a comparison of end-to-end and end-to-side arterial anastomosis Clinical Imaging (2009)33: 116–122
Shruti Gandhi a,, Kajal Patel a, VivekKute b, Maulik Mehta Duplex Doppler ultrasound for detection of significant renal artery stenosis in transplant kidney with end to side arterial anastomosis Clinical Queries: Nephrology 5 (2016) 37–39.
Granata A, Clementi S, Londrino F, Et al :Renal transplant vascular complications: the role of Doppler Ultrasound J Ultrasound.(2014);18(2):101–107.
W.Chen, L. K. Kayler,M. S.Zand, R.et al “Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy,” Clinical Kidney Journal, (2015) 8, (1), 71–78,.
Sharfuddin A Imaging evaluation of kidney transplant recipients. SeminNephrol (2011) 31(3):259–271
Beckmann J, Jackobs S, Klempnauer J Arterial Reconstruction in Kidney Transplantation. Transplantations medizin (2008) 20: 7-12
Restrepo-Schafer IK, Schwerk WB, Muller TF, et al. Intrarenal Doppler flow analysis in patients with kidney transplantation and stable transplant function. Ultraschall Med (1999);20(3):87–92.
Samtleben W. Nephrogenic systemic fibrosis. Radiologe 2007;47(9):778–84.
Ten Dam MA, Wetzels JF. Toxicity of contrast media: an update. Neth J Med (2008);66(10):416–22.
Davidson C, Stacul F, McCullough PA, et al. Contrast medium use. Am J Cardiol (2006);98(6A):42–58.
Published
How to Cite
Issue
Section
Copyright (c) 2023 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
