Extracorporeal Microsurgical Repair of Injured Multiple Donor Kidney Arteries prior to Cadaveric Allotransplantation

Increased Transplantation of Kidneys With Multiple Renal Arteries in the Laparoscopic Live Donor Nephrectomy Era

“…In the literature, an incidence of 18% to 30% of unilateral multiple RAs was described. 16,23,25,31 The incidence of bilateral multiple RAs ranges from only 2% to 15%. 16,23,31 Having the ability to choose between the left and right kidney (to avoid unilateral multiple RAs, for example) has led to right kidney procurement rates of as high as 31% in open donor nephrectomy series.…”

“…This compares with a 15% to 18% incidence of multiple-RA grafts from living donors using the open technique (procurement of either right or left kidneys). 22,25 The drastically changed approach to kidneys with multiple RAs in the laparoscopic live donor nephrectomy era is probably best epitomized by the statement of Ratner et al 15 that " . .…”

“…22,25 This high rate of multiple-RA grafts may theoretically exert an adverse effect on outcome. Previous authors [23][24][25][26] have associated multiple RAs with several posttransplant complications. Therefore, during the initial 2 decades of clinical renal transplantation, such anatomy was even considered to be a transplant contraindication.…”

“…Therefore, during the initial 2 decades of clinical renal transplantation, such anatomy was even considered to be a transplant contraindication. 25 Vascular complications that have been described for multiple-RA grafts include graft thrombosis, RA stenosis, and an increased risk for renovascular hypertension. 23,27 With regard to the ureter, Loughlin et al 24 described a higher incidence of early ureteral necrosis and renal pelvicaliceal fistulas with multiple RAs.…”

Management and Outcome of Living Kidney Grafts with Multiple Arteries

“…Therefore, successful allografts with multiple renal arteries (MRAs) are necessary, and have been made possible by improved techniques, even though MRAs used to be considered a relative contraindication because of the increased risk of vascular and urologic complications. 2,3 Moreover, the likelihood of harvesting kidneys with MRAs is much higher with laparoscopic nephrectomy than with open nephrectomy. This is an issue because laparoscopic nephrectomy is currently used as minimally invasive surgery for living donors.…”