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Ostrowski P, Kotowski MJ, Tejchman K, Szemitko M, Sieńko J, Ostrowski M. The Arterial Anastomosis Between Deep Inferior Epigastric Artery and Small Polar Renal Artery in Kidney Transplantation: A Case Report. Transplant Proc 2022; 54:1145-1147. [PMID: 35568519 DOI: 10.1016/j.transproceed.2022.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
Abstract
The presence of multiple renal arteries is the most common form of vascular anomalies found in donor kidneys. In rare cases, small renal polar arteries may be found. They can be anastomosed with deep inferior epigastric arteries, resulting in vascular augmentation of transplanted kidneys and contributing to better graft function. Renal perfusion may be increased via 2 types of vascular reconstruction known as "turbocharging" and "supercharging". Turbocharging uses vascular sources within the same organ area, whereas supercharging uses distant vascular sources. Using additional vessels can either complicate the surgery or, contradictorily, ease the way of procedure. This case study presents a kidney transplant during which arterial anastomosis between deep inferior epigastric artery and small polar renal artery was performed.
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Affiliation(s)
- P Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland.
| | - M J Kotowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - K Tejchman
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - M Szemitko
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - J Sieńko
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - M Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
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2
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Scheuermann U, Rademacher S, Wagner T, Lederer A, Hau HM, Seehofer D, Sucher R. Influence of Multiple Donor Renal Arteries on the Outcome and Graft Survival in Deceased Donor Kidney Transplantation. J Clin Med 2021; 10:jcm10194395. [PMID: 34640413 PMCID: PMC8509629 DOI: 10.3390/jcm10194395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023] Open
Abstract
AIM Complex arterial reconstruction in kidney transplantation (KT) using kidneys from deceased donors (DD) warrants additional study since little is known about the effects on the mid- and long-term outcome and graft survival. METHODS A total of 451 patients receiving deceased donor KT in our department between 1993 and 2017 were included in our study. Patients were divided into three groups according to the number of arteries and anastomosis: (A) 1 renal artery, 1 arterial anastomosis (N = 369); (B) >1 renal artery, 1 arterial anastomosis (N = 47); and (C) >1 renal artery, >1 arterial anastomosis (N = 35). Furthermore, the influence of localization of the arterial anastomosis (common iliac artery (CIA), versus non-CIA) was analyzed. Clinicopathological characteristics, outcome, and graft and patient survival of all groups were compared retrospectively. RESULTS With growing vascular complexity, the time of warm ischemia increased significantly (groups A, B, and C: 40 ± 19 min, 45 ± 19 min, and 50 ± 17 min, respectively; p = 0.006). Furthermore, the duration of operation was prolonged, although this did not reach significance (groups A, B, and C: 175 ± 98 min, 180 ± 35 min, and 210 ± 43 min, respectively; p = 0.352). There were no significant differences regarding surgical complications, post-transplant kidney function (delayed graft function, initial non-function, episodes of acute rejection), or long-term graft survival. Regarding the localization of the arterial anastomosis, non-CIA was an independent prognostic factor for deep vein thrombosis in multivariate analysis (CIA versus non-CIA: OR 11.551; 95% CI, 1.218-109.554; p = 0.033). CONCLUSION Multiple-donor renal arteries should not be considered a contraindication to deceased KT, as morbidity rates and long-term outcomes seem to be comparable with grafts with single arteries and less complex anastomoses.
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Affiliation(s)
- Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
- Correspondence:
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Tristan Wagner
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany
| | - Andri Lederer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Hans-Michael Hau
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus, TU Dresden, 01307 Dresden, Germany;
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
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3
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Dogan SM, Dogan G, Simsek C, Okut G, Berktas B, Simsek A, Kutluturk K, Taskapan H, Sahin I, Sahin TT, Piskin T, Uslu A. Transplantation Using Renal Grafts With Multiple Renal Arteries: A Putative Study on the Impact of Arterial Reconstruction Technique and Site of Implantation on Outcomes. Transplant Proc 2020; 53:920-926. [PMID: 32919803 DOI: 10.1016/j.transproceed.2020.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/07/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the present retrospective study, we analyzed the outcomes of patients transplanted with grafts with multiple renal arteries (MRAs). PATIENTS AND METHODS In total, 89 patients were transplanted with renal grafts with MRAs from 2003 to 2018. Demographic characteristics; type of donor; warm and cold ischemia times; arterial anastomosis technique; complications; graft function at first month, first year, and last outpatient clinic visit; and patient and graft survival were all retrospectively evaluated. RESULTS The mean age of the patients was 40.4 ± 13.3 years. Fifty-six patients (62.9%) were male. In total, 42 patients (47.2%) received renal grafts from living related donors. In group A (n = 24; 27%), anastomosis was performed separately to the recipient external or internal iliac arteries; in group B (n = 38; 42.7%), the secondary artery was anastomosed to the main artery in a side-to-side fashion to form a single common orifice; in group C (n = 27; 30.3%), secondary arteries were anastomosed to the main renal artery in an end-to-side fashion. Creatinine clearance at the first month was significantly lower for deceased-donor grafts compared to living-donor renal grafts (P < .05). Creatinine clearance in the first postoperative month was significantly lower in group A and creatinine clearance in the first year was significantly lower in group C (P < .05). The best survival was found for anastomosis to the internal iliac artery (P < .05). CONCLUSION MRAs can be safely used and the reconstruction technique does not matter if the graft kidney's arterial supply is preserved and the internal iliac artery is chosen for anastomosis.
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Affiliation(s)
- Sait M Dogan
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Gulec Dogan
- Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cenk Simsek
- Department of Surgery, Izmir Bozyaka Teaching Hospital, Izmir, Turkey
| | - Gokalp Okut
- Department of Surgery, Izmir Bozyaka Teaching Hospital, Izmir, Turkey
| | - Bayram Berktas
- Department of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Arife Simsek
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Koray Kutluturk
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Hulya Taskapan
- Department of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Idris Sahin
- Department of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Turgut Piskin
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adam Uslu
- Department of Surgery, Izmir Bozyaka Teaching Hospital, Izmir, Turkey
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Mehrabi A, Kulu Y, Sabagh M, Khajeh E, Mohammadi S, Ghamarnejad O, Golriz M, Morath C, Bechstein WO, Berlakovich GA, Demartines N, Duran M, Fischer L, Gürke L, Klempnauer J, Königsrainer A, Lang H, Neumann UP, Pascher A, Paul A, Pisarski P, Pratschke J, Schneeberger S, Settmacher U, Viebahn R, Wirth M, Wullich B, Zeier M, Büchler MW. Consensus on definition and severity grading of lymphatic complications after kidney transplantation. Br J Surg 2020; 107:801-811. [PMID: 32227483 DOI: 10.1002/bjs.11587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - S Mohammadi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - G A Berlakovich
- Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - N Demartines
- Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland
| | - M Duran
- Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - L Fischer
- Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - L Gürke
- Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland
| | - J Klempnauer
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany
| | - A Pascher
- Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - P Pisarski
- Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany
| | - J Pratschke
- Department of Surgery, Charité University Hospital, Berlin, Germany
| | - S Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - R Viebahn
- Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany
| | - M Wirth
- Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - M Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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Bachul PJ, Osuch C, Chang ES, Bętkowska-Prokop A, Pasternak A, Szura M, Matyja A, Walocha JA. Crossing Anatomic Barriers-Transplantation of a Kidney with 5 Arteries, Duplication of the Pyelocalyceal System, and Double Ureter. Cell Transplant 2017; 26:1669-1672. [PMID: 28933184 PMCID: PMC5753978 DOI: 10.1177/0963689717722169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
During the time of organ harvest, it is crucial for the kidney procurement team to consider significant vascular anatomical variations. Multiple renal arteries are not uncommon, and unintentional injury can result in an irreversibly damaged kidney graft that needs to be discarded. We present a kidney graft with 5 renal arteries and a single vein that was successfully procured and implanted with good graft function at discharge and at 4-yr follow-up. According to the literature, additional renal arteries can be found in about 33% of kidneys. This is the first study on a kidney with 5 arteries in the published literature, especially in the context of transplantation.
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Affiliation(s)
- Piotr J Bachul
- 1 Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Czesław Osuch
- 3 First Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Ea-Sle Chang
- 4 Saint Louis University Hospital, St Louis, MO, USA
| | | | - Artur Pasternak
- 1 Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Mirosław Szura
- 6 Department of Experimental and Clinical Surgery, Faculty of Health Sciences-Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Matyja
- 3 First Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- 1 Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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6
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Bozkurt B, Tokac M, Dumlu EG, Yalcin A, Kilic M. Our First Experience With Negative Pressure Incision Management System Implemented on the Clean Surgical Incision in the Renal Transplantation Recipient: A Case Report. Transplant Proc 2016; 47:1515-7. [PMID: 26093755 DOI: 10.1016/j.transproceed.2015.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Multiple comorbidities and environmental factors increase the complications of incisional wounds in patients. It was demonstrated in previous prospective and randomized studies that negative pressure wound therapy (NPWT) reduced wound infection and other complications in clean, closed surgical incisions. In this case report, the Prevena incision management system was implemented on the clean, closed surgical incision of a 52-year-old female patient, who was given a renal transplantation from cadaver postoperatively in the operating theater. It was removed from the patient on the fifth day after the operation. Following the removal of Prevena, the wound and surrounding skin of the patient were observed. Wound healing was complete, and no skin lesion or tool-related complication was found around the wound due to NPWT. The Prevena NPWT system can be conveniently and safely implemented on the operational incision in renal transplant recipients in order to prevent surgical wound complications.
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Affiliation(s)
- B Bozkurt
- Organ Transplantation Centre, Ataturk Training and Research Hospital, Ankara, Turkey.
| | - M Tokac
- Organ Transplantation Centre, Ataturk Training and Research Hospital, Ankara, Turkey
| | - E G Dumlu
- Organ Transplantation Centre, Ataturk Training and Research Hospital, Ankara, Turkey
| | - A Yalcin
- Department of General Surgery, Yildirim Beyazit University, Ankara, Turkey
| | - M Kilic
- Department of General Surgery, Yildirim Beyazit University, Ankara, Turkey
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Stein K, Maruschke M, Protzel C, Hakenberg OW. [Allogeneic kidney transplantation. Preoperative, perioperative and postoperative management]. Urologe A 2014; 53:91-101; quiz 102. [PMID: 24389690 DOI: 10.1007/s00120-013-3375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Allogeneic renal transplantation is the best treatment for many patients with chronic renal failure and end-stage kidney disease. Especially the health-related quality of life markedly improves after renal transplantation and the side effects of dialysis treatment as well as the progression of organ and tissue deterioration related to renal failure which are not treated effectively by dialysis are greatly reduced. To achieve good results of renal transplantation, however, the best possible preoperative as well as perioperative and postoperative conditions have to be established and patients on waiting lists need to be well prepared. Interdisciplinary patient care is needed before and after renal transplantation in order to achieve durable and long-term success of renal transplantation.
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Affiliation(s)
- K Stein
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6 , 18055, Rostock, Deutschland,
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