Vascular Complications in Allogeneic Renal Transplantations

Abstract

Background. The incidence of vascular complications during allogeneic renal transplantations ranges from 5% to 15%. They may be donor related (additional polar arteries, multiple renal arteries, multiple renal veins, injured arteries or veins), recipient related (severe atherosclerosis, venous thrombosis, previous transplantation), or technical. In a retrospective study of 666 kidney transplantations, the incidence and treatment of vascular complications were analyzed.Patients/Results. All transplantations were performed in end-to-side technique with aortic patch if available; all kidneys were obtained from brain-dead donors. A total of 89 operations included vascular complications (13.4%). In 46 patients (6.9%), the problem arose intraoperatively, 33 complications (5%) occurred within three weeks, and another 10 (0.3%) were seen later after successful transplantation. In 17 kidneys, major additional polar arteries were encountered, 7 of which were reanastomosed, 10 were ligated. Three kidneys were lost owing to insufficient blood supply to the ureter. In 7 patients, intraoperative vascular service operations had to be carried out owing to stenosis of the iliac artery or massive kinking. Early postoperative complications included bleeding after biopsy, anastomotic leakage, and arterial or venous thrombosis (1 successful venous thrombectomy; 18 of 33 organs were removed). As for late complications, the authors (continued on next page) (Abstract continued) observed 9 transplant renal artery stenoses (TRAS); 8 were treated by percutaneous transluminal angioplasty. One patient developed an iliac aneurysm owing to chronic patch rupture.Conclusion. The majority of intraoperative complications were due to injury of the kidney during donor nephrectomy (21/46). Polar arteries should be reconstructed if possible, especially lower polar arteries, because of the danger of ureteral necrosis. In times of increasing donor organ shortage, only experienced surgeons should perform explantation and transplantation of kidneys to avoid technical faults in a considerable number of organs.