Outcome of Kidney Grafts with Multiple Arteries, Vascular and Urologic Complications

OBJECTIVES: Renal transplantation with multiple arteries is technically demanding and carries
higher risk of vascular and urological complications. The aim of this study is to review graft outcomes
and surgical complications of kidney transplantation with multiple renal arteries retrospectively.
 

MATERIAL and METHODS: The charts of 39 patients who received kidneys with multiple renal
arteries were retrospectively reviewed. The graft function, surgical technique and surgical complications
were recorded.
 

RESULTS: Of the 39 grafts, 34 had 2 arteries, 4 had 3 arteries, and 1 had 4 arteries. Various types of
surgical techniques, mainly in situ separated 2 anastomoses in 16 patients (41,0%) and ex vivo pantaloon
(side-to-side) anastomosis to create a common channel in 24 cases, were performed. Postoperative
vascular complications developed in 3 patients. One graft nephrectomy was done on postoperative day
1 due to renal vein thrombosis. Renal artery stenosis occurred in one patient and bleeding from arterial
anastomosis was repaired in another patient. Only one urological complication was observed. Urinary
leakage from the ureterovesical junction was repaired surgically. Two graft failures occurred due to
acute rejection episodes that developed on the postoperative 2nd and 4th month. Patient survival rate was
100%, while graft survival rate was 97%, 90%, and 90% at the postoperative 1st, 6th, and 12th month,
respectively

CONCLUSIONS: Although grafts with multiple renal arteries carry a relatively higher complication risk, they can be transplanted successfully
using meticulous surgical technique. The type of anastomosis should be decided peroperatively based on graft kidney and recipient vascular
structure.