P. Brady1, W. C. Goggins1, R. S. Mangus1 1Indiana University School Of Medicine,Surgery / Transplant,Indianapolis, IN, USA
Introduction:
There is an increasing shortage of kidney allografts available for transplantation. Each available kidney must be utilized in order to alleviate this shortage. Transplant kidney allografts with multiple renal arteries or veins present added technical complexity when performing the transplant procedure. These grafts may be at higher risk for non-use or for perioperative complications such as graft thrombosis or hematoma. Occasionally, small accessory vessels are ligated which may affect the short- and long-term function of the graft. This study reviews the arterial and venous anatomy for all kidney transplants at a single center over a 17-year period. Outcomes include early graft loss, delayed graft function and long-term graft function.
Methods:
The operative reports for all kidney transplants at a single center between 2001 and 2018 were reviewed. Extracted data included the number of arteries and veins for each graft, as well as type of reconstruction. Ligated vessels were recorded when reported by the surgeon. Delayed graft function was defined as a need for dialysis within 7 days of transplant. Cox regression with a direct entry method was utilized to assess long-term graft function. Operative technique and immunosuppression protocol was similar and consistent for all surgeons during the study period.
Results:
There were 3,504 kidney transplants performed during the study period, 2161 (62%) deceased and 1343 (38%) living donors. Data from 10 surgeons were included (range 10 to 1923 transplants). Donation after circulatory death (DCD) comprised 4% of all donors and 6% of deceased donors. Complete operative reports were available for 98% of grafts. There were 78% of grafts with a single renal artery and 97% with a single renal vein. There was no difference in delayed graft function with grafts that had multiple arteries (2.2% vs 2.5%, p=0.61) or multiple veins (0% vs 2.5%, p=0.16). Risk of graft loss within 7-days of transplant for single and multiple vessels showed no difference (arterial 1% vs 1%, p=0.96; venous 1% vs 1%, p=0.80). Cox regression analysis demonstrated no difference in graft survival at 15-years based on vessel anatomy (p=0.58). Median graft survival for single and multiple vessels was (arterial) 136 and 137 months (p=0.69) and (venous) 136 and 136 months (p=0.95).
Conclusion:
These results demonstrate remarkably consistent results for kidney grafts with standard or with more complex arterial and venous anatomy. These results suggest that kidney grafts with complex anatomy should not be excluded from transplant.