Successful renovascular reconstruction for renal allografts with multiple renal arteries

Abstract

Allografts with multiple renal arteries can be used successfully in kidney transplantation.

Can renal dimensions and the main renal artery diameter point to the presence of an accessory renal artery? a 64-slice CT study

“…For example, a donor kidney without an aRA is preferred because it allows for an easier surgery for both the donor and the recipient (6,18,19). Bleeding due to an invasive procedure performed on an aRA may result in open laparotomy, whereas a missed case of an aRA may cause an infarct in a transplanted kidney and associated hypertension in the recipient (12,17). It is also necessary to know whether an aRA is present prior to investigating the isolated aRA stenosis in a case with normal mRA hemodynamics (4).…”

“…The most important of these is guidance regarding invasive procedures. Knowledge of the arterial anatomy of the kidney, especially prior to surgeries carried out with a small field of view, such as laparoscopic and retroperitoneoscopic nephrectomy, aids in decisions in planning the nephron-sparing surgery and prevents possible perioperative surprises (17,18). For example, a donor kidney without an aRA is preferred because it allows for an easier surgery for both the donor and the recipient (6,18,19).…”

Multiple Renal Arteries in Live Donor Renal Transplantation; Impact on Graft Function and Outcome: A Prospective Cohort Study

“…A study of 393 recipients by Makiyama et al (2003) of grafts with MRA compared those who underwent reconstruction with those who did not [19]. As expected, total ischaemic times were longer in the reconstructed group.…”

“…However, extracorporeal reconstruction while in the cold preservation solution minimizes the warm ischaemia time while allowing for better visualization and easier suturing [19]. Alternatively, the main renal artery can be anastomosed to the recipient allowing earlier reperfusion of the graft while the accessory artery is kept under a soft clamp.…”

“…In general, laparoscopic donor nephrectomy is preferred over open surgery as it is a less invasive procedure, avoids a large surgical scar, reduces post-operative pain and length of hospital stay [19]. There appear to be no differences between the donors with MRA and SRA undergoing laparoscopic nephrectomy in terms of serum creatinine and 1 year graft survival.…”