The new technique of using the epigastric arteries in renal transplantation with multiple renal arteries

Abstract

The most common anatomic variant seen in the donor kidneys for renal transplantation is multiple renal arteries (MRA), which can cause an increased risk of complications. We describe the long-term outcomes of 16 years of experience in 76 kidney transplantations with MRAs. In a new reconstruction technique, we remove arterial clamps after anastomosing the donor to the recipient's main renal vessels, which cause backflow from accessory arteries to prevent thrombosis. By this technique, we reduce the ischemic times as well as the operating times. Both in live or cadaver donor kidneys, lower polar arteries were anastomosed to the inferior epigastric artery and upper polar arteries were anastomosed to the superior epigastric arteries. Injection of Papaverine and ablation of sympathic nerves of these arteries dilate and prevent them from post-operative spasm. Follow-up DTPA renal scan in all patients showed good perfusion and function of the transplanted kidney, except two cases of polar arterial thrombosis. Mean creatinine levels during at least two years of follow-up remained acceptable. Patient and graft survival were excellent. No cases of ATN, hypertension, rejection and urologic complications were found. In conclusion, this technique can be safely and successfully utilized for renal transplantation with kidneys having MRAs, and may be associated with a lower complication rate and better graft function compared with the existing techniques.

Investigations on renal vascularisation pathology in the Polish population. 1. Incidence of multiple kidney arteries

“…Knowledge of the variety of renal arteries should be a beacon in such vascular procedures as therapeutic embolisation and angioplasty, as well as management of renal ischaemia during transplantation [7,25]. Although multiple kidney artery transplants are burdened with some dose of risk, there is a consensus that the obtained results tend to be comparable to kidney transplantations with a single renal artery [1,3,12,39]. Singh et al [37] even performed partial laparoscopic nephrectomy in 333 patients with renal tumours, in which multiple renal arteries was not a particular problem.…”

“…We determined the above-mentioned phenomenon by comparing results obtained from 7 clinical investigations with 6 autopsy study results. Clinical investigations [1,11,15,22,31,34,37] that comprised 3059 kidney transplants revealed 523 cases of multiple kidney arteries (17.1%), with the prevalence rate ranging between 7.79% [22] and 31.4% [37]. On the other hand, in the autopsy material [2,21,23,24,32,38], 213 (18.7%) multiple renal arteries were diagnosed of the 1141 investigated kidneys, ranging between 2% [23] and 24.8% [38].…”

Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries

“…In 2013, the technique of using epigastric arteries in renal transplantation was re-described [ 48 ]. This technique was in use already in 2001 [ 112 ].…”

Arterial reconstructions of kidney allograft

“…Other authors report about good results of additional pole renal artery anastomosis with lower epigastric recipient's artery like "end-to-end" [2,3,12,13,15]. There is a point of view, according to which it is better to anastomose upper pole renal artery with upper epigastric artery, lower pole artery of graft with upper epigastric recipient's artery [23]. It is possible to perform the anastomosis of additional artery with the main stem of renal artery like "toward the end".…”