1
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Lim EJ, Fong KY, Li J, Chan YH, Aslim EJ, Ng LG, Gan VHL. Single versus multiple renal arteries in living donor kidney transplantation: A systematic review and patient-level meta-analysis. Clin Transplant 2023; 37:e15069. [PMID: 37410577 DOI: 10.1111/ctr.15069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/26/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Grafts with multiple renal arteries (MRAs) were historically considered a relative contraindication to transplantation due to the higher risk of vascular and urologic complications. This study aimed to evaluate graft and patient survival between single renal artery (SRA) and MRA living-donor kidney transplants. METHODS An electronic literature search was conducted on PubMed, EMBASE, and Scopus for prospective or retrospective studies comparing SRA versus MRA in living donor renal transplantation, with the provision of Kaplan-Meier curves for recipient overall survival (OS) or graft survival (GS). A graphical reconstructive algorithm was used to obtain OS and GS of individual patients, which was then pooled under random-effects individual patient data (IPD) meta-analysis using Cox-models to determine hazard ratios (HRs) and 95% confidence intervals (CIs). Meta-regression of baseline covariates versus HRs of OS and GS was performed for variables reported in 10 or more studies. RESULTS Fourteen studies were retrieved, of which 13 (8400 patients) reported OS and 9 (6912 patients) reported GS. There were no significant differences in OS (shared-frailty HR = .94, 95%CI = .85-1.03, p = .172) or GS (shared-frailty HR = .95, 95%CI = .83-1.08, p = .419) between SRA and MRA. This comparison remained non-significant even when restricted to open- or laparoscopic-only studies. Meta-regression yielded no significant associations of GS with donor age, recipient age, and percentage of double renal arteries within the MRA arm. CONCLUSIONS The similar rates of GS and OS between MRA and SRA grafts suggest that there is no need for discrimination between the two when evaluating donors for nephrectomy.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingqiu Li
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
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2
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Bansal S, Rathi D, Zafar F, Ghosh P, Khera R, Ahlawat R. Renal transplant outcomes in allografts with multiple versus single renal arteries. INDIAN JOURNAL OF TRANSPLANTATION 2023. [DOI: 10.4103/ijot.ijot_95_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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3
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Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green. J Clin Med 2022; 11:jcm11216585. [PMID: 36362813 PMCID: PMC9656022 DOI: 10.3390/jcm11216585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Ureteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indocyanine green (ICG) fluorescence angiography. This bicentric historic cohort study, conducted between November 2015 and December 2019, included 196 kidney transplantations. The associations between quantitative perfusion parameters of near-infrared fluorescence angiography with ICG and the occurrence of different grades of ureterovesical anastomosis complications in the context of donor, recipient, periprocedural, and postoperative characteristics were evaluated. Post-transplant ureterovesical anastomosis complications occurred in 18%. Complications were defined and graded into three categories. They were associated with the time on dialysis (p = 0.0025), the type of donation (p = 0.0404), and the number of postoperative dialysis sessions (p = 0.0173). Median ICG ingress at the proximal ureteral third was 14.00 (5.00–33.00) AU in patients with and 23.50 (4.00–117.00) AU in patients without complications (p = 0.0001, cutoff: 16 AU, sensitivity 70%, specificity 70%, AUC = 0.725, p = 0.0011). The proposed definition and grading of post-transplant ureterovesical anastomosis complications is intended to enable valid comparisons between studies. ICG Fluorescence angiography allows intraoperative quantitative assessment of ureteral microperfusion during kidney transplantation and is able to predict the incidence of ureterovesical anastomosis complications. Registration number: NCT-02775838.
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4
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Black AJ, Harriman D, Nguan C. Contemporary risk factors for ureteral stricture following renal transplantation. Can Urol Assoc J 2022; 16:E321-E327. [PMID: 35099386 PMCID: PMC9245959 DOI: 10.5489/cuaj.7648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Allograft ureteral strictures after renal transplantation impact graft function and increase patient morbidity. They can be challenging to treat and may require complex surgical repair. Therefore, the objective of this study was to identify contemporary risk factors for the development of post-renal transplant ureteral strictures. METHODS A retrospective analysis was performed on all renal transplant patients at Vancouver General Hospital from 2008-2019. Demographics, clinical parameters, and outcomes were compared between patients who did and did not develop ureteral strictures. Putative risk factors for ureteral stricture were analyzed using logistic regression. RESULTS A total of 1167 patients were included with a mean followup of 61.9±40.8 months. Ureteral strictures occurred in 25 patients (2.1%). Stricture patients had no demographic differences compared to non-stricture patients but had significantly higher rates of postoperative complications, longer hospital stays, and decreased renal function one year post-transplant (all p<0.05). On multivariable analysis, cold ischemia time >435 minutes (odds ratio [OR] 43.9, confidence interval [CI] 1.6-1238.8, p=0.027), acute rejection (OR 3.0, CI 1.1-7.4, p=0.027), and postoperative complications (OR 112.4, CI 2.4-5332.6, p=0.016) were risk factors for stricture. CONCLUSIONS Renal transplant patients with ureteral stricture experience greater morbidity and reduced post-transplant renal function compared to non-stricture patients. Our findings support attempts to reduce cold ischemia time, acute rejection, and postoperative complications to mitigate this potential complication. Our study is limited by the low incidence of ureteral stricture resulting in a small sample of stricture patients. Future research in a larger, multicenter setting is warranted.
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Affiliation(s)
- Anna J Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - David Harriman
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Nguan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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5
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Tabbara MM, Guerra G, Riella J, Abreu P, Alvarez A, Vianna R, Chen L, Morsi M, Gaynor JJ, Gonzalez J, Ciancio G. Creating a Single Inflow Orifice From Living Donor Kidney Allografts With Multiple Renal Arteries. Transpl Int 2022; 35:10212. [PMID: 35497891 PMCID: PMC9046561 DOI: 10.3389/ti.2022.10212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
Background: Multiple renal arteries (MRA) are often encountered during living-donor kidney transplantation (LDKT), requiring surgeons to pursue complex renovascular reconstructions prior to graft implantation. With improvements in reconstruction and anastomosis techniques, allografts with MRA can be successfully transplanted with similar outcomes to allografts with a single renal artery. Here, we describe in detail various surgical techniques for reconstruction of MRA grafts with the intent of creating a single arterial inflow. Methods: We retrospectively reviewed the medical records of all LDKT recipients with laparoscopically procured MRA kidneys between March 2008 and July 2021. Recipient and donor characteristics, operative data, type of reconstruction, and recipient outcomes were analyzed. The primary outcomes were the incidence of developing delayed graft function (DGF) and/or a vascular or urological complication within 12 months post-transplant. Results: Seventy-three LDKT recipients of MRA donor allografts were evaluated. Two renal arteries (RA) were encountered in 62 allografts (84.9%) and three RA in 11 allografts (15.1%). Renal artery reconstruction was performed in 95.8% (70/73) of patients. Eighteen different reconstruction techniques of MRA were utilized, the most common being side-to-side anastomosis in allografts with two RA (N = 44) and side-to-side-to-side anastomosis in allografts with three RA (N = 4). Interposition grafting was performed in seven cases (9.6%). A single ostium was created in 69 cases (94.5%), and the median warm ischemia time was 27 (range 20–42) minutes. None of the patients developed DGF or post-operative vascular or urological complications. Median creatinine at 3, 6, and 12 months post-transplant remained stable at 1.1 mg/dl. With a median follow-up of 30.4 months post-transplant, only one graft failure has been observed–death-censored graft survival was 98.6%. Conclusion: Complex reconstruction techniques to create a single renal artery ostium for graft implantation anastomosis in allografts with MRA show acceptable warm ischemic times, with no increased risk of post-operative vascular or urological complications.
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Affiliation(s)
- Marina M Tabbara
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Giselle Guerra
- Division of Nephrology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Juliano Riella
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Phillipe Abreu
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Angel Alvarez
- Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Rodrigo Vianna
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Linda Chen
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Mahmoud Morsi
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Jeffrey J Gaynor
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Javier Gonzalez
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida.,Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
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6
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GÜNDOĞDU H, AYDIN AKSU S, KARA M. Comparison of low-dose contrast computed tomography angiography findings with surgical results in living kidney donors. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1014834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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7
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Giron-Luque F, Baez-Suarez Y, Garcia-Lopez A, Patino-Jaramillo N. Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy. Res Rep Urol 2022; 14:23-31. [PMID: 35118016 PMCID: PMC8801362 DOI: 10.2147/rru.s341028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Vascular multiplicity is the most frequent anatomic variation in kidney donors. Despite concerns about risks, these allografts are increasingly used to overcome the shortage of kidney donors. The safety and clinical outcomes in living kidney donors were evaluated with vascular multiplicity after hand-assisted laparoscopic living donor nephrectomy (HALDN). Patients and Methods Data from all living kidney donors who underwent HALDN from 2008 to 2021 was retrospectively reviewed. Patients were divided into two groups as single (SRV) and multiple renal vessels (MRV), and a comparative analysis was done. The primary outcomes include operating room time (ORT), days of hospital stay, estimated blood loss, complications, conversion, and re-operations. Results MRV were present in 166 out of 612 donors (27.1%). Among those, 10 (1.6%) donors had simultaneous multiple arteries and veins. Additionally, the prevalence of artery and vein multiplicity was 21.8% (n = 134) and 3.5% (n = 22), respectively. Warm ischemia time was significantly different among the two groups but not clinically important. The number of conversions to open technique, the mean ORT, the median blood loss, and days of hospital stay were similar between the SRV and MRV groups, without significant differences. According to the modified Clavien-classification system, no differences were found in the complication rates between the two groups (p = 0.29). Complication rates were 3.3% and 3.6% for the SRV and MRV groups, respectively. Conclusion HALDN is a procedure with safe intraoperative results, even with vascular multiplicity. The presence of multiple renal arteries or veins has no negative impact on the outcome of the donor after living donor nephrectomy.
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Affiliation(s)
| | | | - Andrea Garcia-Lopez
- Research Department, Colombiana de Trasplantes, Bogotá, Colombia
- Correspondence: Andrea Garcia-Lopez Research Department, Colombiana de Trasplantes, Av Carrera 30, No. 47A-74, Bogotá, ColombiaTel +57 300 502 4618 Email
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8
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Husain SA, King KL, Robbins-Juarez S, Adler JT, McCune KR, Mohan S. Number of Donor Renal Arteries and Early Outcomes after Deceased Donor Kidney Transplantation. KIDNEY360 2021; 2:1819-1826. [PMID: 35373010 PMCID: PMC8785844 DOI: 10.34067/kid.0005152021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
Background Anatomic abnormalities increase the risk of deceased donor kidney discard, but their effect on transplant outcomes is understudied. We sought to determine the effect of multiple donor renal arteries on early outcomes after deceased donor kidney transplantation. Methods For this retrospective cohort study, we identified 1443 kidneys from 832 deceased donors with ≥1 kidney transplanted at our center (2006-2016). We compared the odds of delayed graft function and 90-day graft failure using logistic regression. To reduce potential selection bias, we then repeated the analysis using a paired-kidney cohort, including kidney pairs from 162 donors with one single-artery kidney and one multiartery kidney. Results Of 1443 kidneys included, 319 (22%) had multiple arteries. Multiartery kidneys experienced longer cold ischemia time, but other characteristics were similar between groups. Delayed graft function (50% multiartery versus 45% one artery, P=0.07) and 90-day graft failure (3% versus 3%, P=0.83) were similar between groups before and after adjusting for donor and recipient characteristics. In the paired kidney analysis, cold ischemia time was significantly longer for multiartery kidneys compared with single-artery kidneys from the same donor (33.5 versus 26.1 hours, P<0.001), but delayed graft function and 90-day graft failure were again similar between groups. Conclusions Compared with single-artery deceased donor kidneys, those with multiple renal arteries are harder to place, but experience similar delayed graft function and early graft failure.
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Affiliation(s)
- S Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York.,The Columbia University Renal Epidemiology Group, New York, New York
| | - Kristen L King
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York.,The Columbia University Renal Epidemiology Group, New York, New York
| | - Shelief Robbins-Juarez
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
| | - Joel T Adler
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, Massachusetts
| | - Kasi R McCune
- Department of Surgery, Kidney and Pancreas Transplant Program, Columbia University College of Physicians & Surgeons, New York, New York
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York.,The Columbia University Renal Epidemiology Group, New York, New York.,Department of Epidemiology, Mailman School of Public Health, New York, New York
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9
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Colak H, Kivılcim T, Unverdi OF, Yildiz G, Gurkan A. Description and Outcomes of Three Different End-to-Side Microsurgical Techniques for the Anastomosis of Accessory Renal Artery With the Dominant Renal Artery in Kidney Transplantation. Transplant Proc 2021; 53:2900-2906. [PMID: 34782171 DOI: 10.1016/j.transproceed.2021.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In this study, we compared the outcomes of three different surgical microscope-assisted end-to-side anastomosis techniques between the dominant and accessory renal arteries during living donor kidney transplant. METHODS The demographics, serum creatinine levels, warm and cold ischemia times, rate of complications, and incidence of delayed graft function of 135 kidney recipients were analyzed according to the type of arterial anastomosis. Group A (n = 98) had one dominant renal artery (DRA) with one end-to-side anastomosis to the external iliac artery (EIA) using a surgical microscope. Group B (n = 17) had one DRA plus one accessory renal artery (ARA) with two separate end-to-side anastomoses to the EIA using a surgical microscope. Group C (n = 20) had one DRA with end-to-side anastomosis to the EIA and one ARA with an ex vivo on-bench end-to-side anastomosis to the DRA using a surgical microscope. RESULTS Compared with groups A and B, the cold ischemia time and the rate of delayed graft function were significantly higher in group C (P ≤ .001). At 6 months after transplant, group B demonstrated a higher creatinine value (2.40 ± 3.41 mg/dL) than group A and group B (P = .032). Also, the decrease in creatinine at postoperative month 6 was limited in group B as compared with groups A and C. CONCLUSIONS An end-to-side anastomosis between ARA (group B) and DRA (group A) of the kidney graft using a surgical microscope on the bench ex vivo results in superior outcomes. Single arterial anastomosis techniques are associated with a better function in a 6-month follow-up than two separate arterial anastomoses.
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Affiliation(s)
- Hulya Colak
- Department of Nephrology, Faculty of Medicine, İzmir Health Sciences University Tepecik, Izmir, Turkey.
| | - Taner Kivılcim
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Omer Faruk Unverdi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Gursel Yildiz
- Department of Nephrology, Cam Sakura Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Alp Gurkan
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
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10
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O'Kelly F, Lorenzo AJ, Zubi F, De Cotiis K, Farhat WA, Koyle MA. The impact of multiple donor renal arteries on perioperative complications and allograft survival in paediatric renal transplantation. J Pediatr Urol 2021; 17:541.e1-541.e11. [PMID: 33883096 DOI: 10.1016/j.jpurol.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of using allografts with multiple renal arteries in paediatric kidney transplantation has not been clearly established. The aim of this study was to determine whether kidney grafts with multiple arteries pose any adverse effects upon perioperative surgical outcomes, and graft survival up to 12 months post-transplant. OBJECTIVE The objective of this study was to perform a comparative analysis of a minimum of 12-month graft survival and transplant renal function in paediatric renal transplant recipients receiving single versus multiple donor arteries, and to assess perioperative and early post-operative surgical outcomes. STUDY DESIGN A retrospective divisional chart review of 379 transplants performed (2000-2018), of which 90 (23.7%) contained multiple donor arteries. The number of arteries of the graft, donor type, vascular reconstruction technique, occurrence of urological and vascular complications, estimated GFR and graft survival up to 12 months post-transplantation, graft loss and mortality were analysed. Comparisons in baseline characteristics and outcome measures were made between both groups. RESULTS No significant differences were found in age (p = 0.42), BMI (p = 0.39), estimated intraoperative blood loss (p = 0.14), overall (p = 0.63) or warm ischaemic time (p = 0.37). 51.3% patients with multiple donor arteries underwent an ex vivo reconstruction. There were no differences in the site of arterial anastomosis (aorta, external iliac, internal iliac), or anastomotic type (end-side; end-end). Whilst there was a significantly higher post-operative lymphocoele rate in the multiple vessel cohort (p = 0.024), there was no increase in post-transplant urine leaks, rejection episodes, graft loss (1.1% multiple vs 2.1% single), perioperative complications (p = 0.68), or estimated GFR at 1 month (p = 0.9) or at 1 year (p = 0.67). DISCUSSION We demonstrated in this study that there was no significant difference in postoperative complications up to 3 months, eGFR and renal function up to 1 year, and graft survival up to 4 years post transplantation irrespective of allograft type or reconstruction technique. There was however, a higher rate of lymphocoeles in the multiple artery cohort. The results seen here broadly mirror trends seen in adult studies, however, there is little data available from paediatric series. CONCLUSION Our study demonstrates that multiple renal artery allografts - previously been considered to carry a high complication risk - can be safely used for paediatric renal transplantation with equivalent perioperative complications and graft outcomes to single artery allografts.
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Affiliation(s)
- F O'Kelly
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Paediatric Urology, Beacon Hospital, University College, Dublin, Ireland.
| | - A J Lorenzo
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - F Zubi
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - K De Cotiis
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, Neymours/duPont Childrens Hospital, Delaware, USA
| | - W A Farhat
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, American Family Childrens Hospital, Wisconsin, USA
| | - M A Koyle
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
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11
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Garcia LE, Parra N, Gaynor JJ, Baker L, Guerra G, Ciancio G. Clinical Outcomes Following Single vs. Multiple Vessel Living-Donor Kidney Transplantation: A Retrospective Comparison of 210 Patients. Front Surg 2021; 8:693021. [PMID: 34195224 PMCID: PMC8236516 DOI: 10.3389/fsurg.2021.693021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The use of living-donor kidney allografts with multiple vessels continues to rise in order to increase the donor pool. This requires surgeons to pursue vascular reconstructions more often, which has previously been associated with a higher risk of developing early post-transplant complications. We therefore wanted to investigate the prognostic role of using living-donor renal allografts with a single artery (SA) vs. multiple arteries (MA) at the time of transplant. Methods: We retrospectively analyzed a cohort of 210 consecutive living-donor kidney transplants performed between January, 2008 and March, 2019, and compared the incidence of developing postoperative complications and other clinical outcomes between SA vs. MA recipients. Results: No differences were observed between SA (N = 161) and MA (N = 49) kidneys in terms of the incidence of developing a postoperative (or surgical) complication, a urologic complication, hospital length of stay, delayed graft function, estimated glomerular filtration rate at 3 or 12 mo post-transplant, and graft survival. Conclusions: The use of live-kidney allografts with MA requiring vascular reconstruction shows excellent clinical outcomes and does not increase the risk of developing postoperative complications or other adverse outcomes when compared with SA renal allografts.
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Affiliation(s)
- Leonardo E Garcia
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Natalia Parra
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jeffrey J Gaynor
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.,Departments of Surgery and Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lauren Baker
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Giselle Guerra
- Division of Nephrology, Department of Medicine, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gaetano Ciancio
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.,Departments of Surgery and Urology, University of Miami Miller School of Medicine, Miami, FL, United States
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12
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Vincenzi P, Gonzalez J, Guerra G, Gaynor JJ, Alvarez A, Ciancio G. Complex Surgical Reconstruction of Upper Pole Artery in Living-Donor Kidney Transplantation. Ann Transplant 2021; 26:e926850. [PMID: 33446626 PMCID: PMC7814512 DOI: 10.12659/aot.926850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The use of allografts with multiple renal arteries has increased in the era of laparoscopic donor nephrectomy. Although several studies recommend reconstructing lower pole arteries (LPAs) to reduce risk of urologic complications, it is common opinion to ligate upper pole arteries (UPAs) with a diameter less than 2 mm because of increased risk of thrombosis related to their reconstruction. This retrospective study evaluates the feasibility and safety of reconstructing thin UPAs during living-donor kidney transplantation, with the goal of maintaining the integrity of the graft and assuring its maximal function. Material/Methods Data from 922 living-donor kidney transplants performed between 2009 and 2019 were reviewed. Six cases with UPAs were identified (0.65%). The study endpoints were incidence of allograft vascular and urologic complications, slow graft function, delayed graft function, graft failure, and graft and patient survival. Results The UPAs had a mean diameter of 1.8±0.28 mm. Methods of reconstruction included: interposition graft (n=2), end-to-side anastomosis inside the renal hilum to a branch of the main renal artery (n=3), and side-to-side anastomosis with the main renal artery (n=1). Additional reconstruction of LPAs (n=2) and main renal arteries (n=2) was performed. During a median (range) follow-up of 14.5 (9–49) months no complications were observed. Conclusions Ex vivo reconstruction of UPAs with a diameter less than 2 mm is worth attempting, particularly in the setting of living-donor kidney transplantation.
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Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Javier Gonzalez
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giselle Guerra
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Department of Medicine, Division of Nephrology, Miami Transplant Institute, Miami, FL, USA
| | - Jeffrey J Gaynor
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Angel Alvarez
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Department of Urology, Miami Transplant Institute, Miami, FL, USA
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13
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Li Y, Song Y, Hu W, Wang X, Xiao Y, Huang C. Methylene blue usage for determining accessory artery ligation in donor kidneys. Surg Innov 2020; 28:458-464. [PMID: 33124503 DOI: 10.1177/1553350620971474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. We present a technique for determining whether to ligate or preserve accessory arteries in donor kidneys before implantation. Methods. Forty-three living-related donor kidneys in patients from January 2014 to February 2018 at our institution were included, all of which had dual arteries without the same stem. Among them, 19 cases of accessory arterial blood supply were evaluated using methylene blue (MB) perfusion, and accessory arteries supplying less than 10% of the total MB perfusion volume were ligated. The other 24 cases were assessed using a conventional method in which arteries with diameters less than 2 mm were ligated. The back-table surgical time, Doppler ultrasonography index, renal function and complications were compared between the 2 groups. Results. All patients underwent successful kidney transplantation. The back-table surgical time in the MB group was longer than that in the conventional group (42.70 ± 4.70 min vs 34.64 ± 5.30 min, P < .05). The serum creatinine level in the MB group was significantly lower than that in the conventional group 1 month after the operation (103.15 ± 19.26 μmol/L vs 119.17 ± 28.32 μmol/L, P < .05). No differences in the Doppler ultrasonography index or postoperative complications were noted. Conclusions. MB perfusion provides an easy and effective method to make decisions regarding arterial ligation and helps preserve renal function without increasing the number of complications after transplantation.
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Affiliation(s)
- Yang Li
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Yajun Song
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Wengang Hu
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Xu Wang
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Ya Xiao
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
| | - Chibing Huang
- Department of Urology, The Second Affiliated Hospital of the Army Medical University, China
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14
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Fitzpatrick J, Chmelo J, Nambiar A, Fuge O, Page T, Sen G, Soomro N, Rix D, Rogers A, Talbot D, Veeratterapillay R. Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels. Urol Ann 2020; 12:266-270. [PMID: 33100753 PMCID: PMC7546076 DOI: 10.4103/ua.ua_96_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/13/2020] [Indexed: 11/07/2022] Open
Abstract
Introduction: In kidney transplantation, total laparoscopic live donor nephrectomy (TLLDN) in the presence of multiple renal arteries (MRA) is technically challenging and has traditionally been associated with higher complication rates. We report our experience of using MRA grafts procured by TLLDN. Materials and Methods: Patients undergoing TLLDN at our center (2004–2014) was identified from a prospectively maintained database and divided into single renal arteries (SRA) or MRA groups. Recipient perioperative parameters, postoperative complications, and long-term graft survival were analyzed. Results: Of 465 patients, 106 had MRA and 359 had an SRA. There were six vascular complications in the SRA group and two in the MRA group (1.7% vs. 1.8%). There were eight ureteric complications requiring intervention in the SRA group compared to three in the MRA group (4% vs. 3%; P = 0.45). Acute rejection was observed in 12% of the SRA group compared to 9% in the MRA group (P = 0.23). One-, 5- and 10-year graft survivals were 98.2%, 91.3%, and 89.8% in the MRA group versus 98.0%, 90.4%, and 77.5% in the SRA group (log-rank P = 0.13). Conclusion: The use of MRA grafts procured by TLLDN has comparable complication rates to SRA grafts and should not preclude selection for renal transplantation.
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Affiliation(s)
- John Fitzpatrick
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Jakub Chmelo
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Arjun Nambiar
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Oliver Fuge
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Toby Page
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Gourab Sen
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Naeem Soomro
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - David Rix
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Alistair Rogers
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - David Talbot
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
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15
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Sevmis M, Demir ME, Merhametsiz O, Aktas S, Sevmis S, Uyar M. Grafts With Multiple Renal Arteries in Kidney Transplantation. Transplant Proc 2020; 53:933-940. [PMID: 32950261 DOI: 10.1016/j.transproceed.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/21/2020] [Accepted: 07/11/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Renal grafts with multiple renal arteries (MRA) are a compelling issue in surgery of kidney transplantation. Transplantations using "grafts with MRA" have conflicting results. Here, we present our experiences on the issue. METHOD This is a single-center, observational, descriptive study. One hundred ninety-nine patients with end-stage renal disease received a kidney graft from their living- or deceased-related donors in our center between July 2016 and May 2017. We included all recipients to the study. Patients were divided into the following 2 groups: Group 1, recipients who received a renal graft with single renal artery, and Group 2, recipients who received a renal graft with MRA. Groups were compared for estimated glomerular filtration rates (months 1-3 and 12), delayed graft function, and graft survival. Data were analyzed by using SPSS for Windows version 15. RESULTS One hundred ninety-five recipients with all documented data were analyzed. Graft function was compared between 2 groups in months 1, 3, and 12 and found both to have similar outcomes. MRA has been indicated to have no impact on delayed graft function, higher risk for vascular injury, and biopsy-proven acute tubular necrosis. Also, anastomosis sides have been found to have no importance on graft function in recipients with MRA (P > .05 between all sides). CONCLUSION Our study indicates grafts with MRA and grafts with a single renal artery have comparable results in the first post-transplant year.
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Affiliation(s)
- Murat Sevmis
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Mehmet Emin Demir
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey.
| | - Ozgur Merhametsiz
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey
| | - Sema Aktas
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Sinasi Sevmis
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Murathan Uyar
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey
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16
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Nataraj SA, Zafar FA, Ghosh P, Ahlawat R. Feasibility and Functional Outcome of Robotic Assisted Kidney Transplantation Using Grafts With Multiple Vessels: Comparison to Propensity Matched Contemporary Open Kidney Transplants Cohort. Front Surg 2020; 7:51. [PMID: 33195380 PMCID: PMC7477351 DOI: 10.3389/fsurg.2020.00051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/06/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction: The aim of the study was to report the perioperative and functional results of Robotic assisted kidney transplantation (RAKT) in Grafts with multiple vessels (GMVs) and compare it to the results of Open kidney transplantation (OKT) with GMVs. Materials and Methods: Patients undergoing RAKT from living donors using GMVs were reviewed from prospectively collected RAKT database at our institution between March 2013 and March 2018. Patient undergoing Open kidney transplantation (OKT) using GMVs served as controls. Ex-vivo bench surgical reconstruction of GMVs was done according to specific anatomy. Propensity score matching was used to balance the sample size in the two groups. Results: Of 153 RAKT and OKT procedures, 86 cases were eligible for propensity score matching for the statistically significant variables (standardized difference >0.10) and 43 procedures were assigned to each group. Median anastomoses, total and cold ischemia and rewarming times did not differ significantly between the RAKT and OKT groups. In comparison with OKT in GMVs we found that RAKT with GMVs had less pain score on post op 2nd day (p = 0.03). There was also a significant difference in mean analgesic requirement (p = 0.02), hospital stay (p = 0.05) and incision length (p = 0.04). Most of the major, minor surgical, and medical postoperative complications were comparable between the two groups except for wound related events (p = 0.002). Conclusion: Multiplicity of renal vessels in RAKT does not adversely affect patient or graft survival compared with the OKT. Satisfactory functional outcome can be achieved by RAKT similar to OKT in GMVs. RAKT seems to have advantage over OKT in that it is less invasive and has the potential to cause fewer low grade complications. Small sample size and short follow-up are the main limitations of the study.
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Affiliation(s)
| | - Feroz Amir Zafar
- Institute of Urology and Robotic Surgery Medanta, The Medicity Gurgaon, Gurgaon, India
| | - Prasun Ghosh
- Institute of Urology and Robotic Surgery Medanta, The Medicity Gurgaon, Gurgaon, India
| | - Rajesh Ahlawat
- Institute of Urology and Robotic Surgery Medanta, The Medicity Gurgaon, Gurgaon, India
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17
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Fananapazir G, Tse G, Di Geronimo R, McVicar J, Perez R, Santhanakrishnan C, Sageshima J, Troppmann C. Urologic complications after transplantation of 225 en bloc kidneys from small pediatric donors ≤20 kg: Incidence, management, and impact on graft survival. Am J Transplant 2020; 20:2126-2132. [PMID: 31984616 DOI: 10.1111/ajt.15792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 01/25/2023]
Abstract
Pediatric en bloc kidney transplants (EBKs) from small deceased pediatric donors are associated with increased early graft loss and morbidity. Yet, urologic complications post-EBK and their potential impact on graft survival have not been systematically studied. We retrospectively studied urological complications requiring intervention for 225 EBKs performed at our center January 2005 to September 2017 from donors ≤20 kg into recipients ≥18 years. Overall ureteral complication incidence after EBK was 9.8% (n = 22) (12% vs 2% for EBK donors < 10 vs ≥ 10 kg, respectively [P = .031]). The most common post-EBK urologic complication was a stricture (55%), followed by urine leak (41%). In all, 95% of all urologic complications occurred early within 5 months posttransplant (median, 138 days). Urologic complications could be successfully managed nonoperatively in 50% of all cases and had no impact on graft or patient survival. In summary, urologic complications after EBK were common, associated with lower donor weights, occurred early posttransplant, and were often amenable to nonoperative treatment, without adversely affecting survival. We conclude that the higher urologic complication rate after EBK (1) should not prevent increased utilization of small pediatric donor en bloc kidneys for properly selected recipients, and (2) warrants specific discussion with EBK recipients during the preoperative consent process.
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Affiliation(s)
- Ghaneh Fananapazir
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Gary Tse
- Department of Radiology, Long Beach Medical Center, Long Beach, California
| | - Ryan Di Geronimo
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - John McVicar
- Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | - Richard Perez
- Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | | | - Junichiro Sageshima
- Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | - Christoph Troppmann
- Department of Surgery, University of California Davis Medical Center, Sacramento, California
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18
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Broudeur L, Karam G, Rana Magar R, Glemain P, Loubersac T, Fosse A, De Vergie S, Chelghaf I, Perrouin-Verbe MA, Rigaud J, Branchereau J. Right Kidney Mini-Invasive Living Donor Nephrectomy: A Safe and Efficient Alternative. Urol Int 2020; 104:859-864. [PMID: 32702689 DOI: 10.1159/000509064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Right kidney living donor transplantation is considered more difficult and associated with more complications. The objective was to evaluate donor safety and graft function of right hand-assisted laparoscopic donor nephrectomy (HALDN). METHODS A total of 270 consecutive HALDN procedures have been performed in our institution up to April 2017. We retrospectively compared the outcomes of right-sided nephrectomy (R-HALDN) to left-sided nephrectomy (L-HALDN) to evaluate donor safety and graft function of R-HALDN. RESULTS Sixty-seven right kidneys were removed for functional asymmetry in favour of left kidney (35/67) or left kidney multiple arteries (28/67). Among the donors, neither conversion to open surgery nor preoperative blood transfusion was necessary. There was no significant difference in operative time, compared to L-HALDN group (170 ± 37 min vs. 171 ± 32 min; p value = 0.182). Warm ischaemia time was significantly longer for R-HALDN (4.0 ± 1.6 min vs. 3.0 ± 1.7 min; p < 0.001). There was no significant difference in terms of post-operative complications and serum Cr levels. Among the recipients, there were no graft venous thrombosis. There was no significant difference in delayed graft function (3 for R-HALDN group and 8 for L-HALDN group; p value = 0.847), serum Cr levels, and graft survival. CONCLUSION R-HALDN is a safe procedure for kidney donors, with excellent graft function for the recipients, compared to L-HALDN.
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Affiliation(s)
- Lucas Broudeur
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France,
| | - Georges Karam
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Reshma Rana Magar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Pascal Glemain
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Thomas Loubersac
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Arthur Fosse
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Stéphane De Vergie
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Ismaël Chelghaf
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | | | - Jérôme Rigaud
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.,Centre Hospitalier Universitaire de Nantes, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
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19
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Yamanaga S, Freise CE, Stock PG, Rosario A, Fernandez D, Kobayashi T, Tavakol M, Kang SM. Inferior Long-Term Graft Survival of Suboptimal Kidneys After Living Donor Kidney Transplantation. Transplant Proc 2020; 52:1734-1740. [PMID: 32446691 DOI: 10.1016/j.transproceed.2020.01.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND In living donors, if both kidneys are considered to be of equal quality, the side with favorable anatomy for transplant is usually selected. A "suboptimal kidney" is a kidney that has a significant abnormality and is chosen to maintain the principle of leaving the better kidney with the donor. We hypothesized that the long-term outcome of suboptimal kidney is inferior to that of the normal kidney. METHODS In a retrospective analysis of 1744 living donor kidney transplantations performed between 1999 and 2015 at our institution, 172 allografts were considered as a suboptimal kidney (9.9%). Median length of follow-up after living donor kidney transplantation was 59.5 months (interquartile range 26.3-100.8). This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor source. RESULTS The reasons for suboptimal kidneys were cysts or tumors (46.5%), arterial abnormalities (22.7%), inferior size or function (19.8%), and anatomic abnormalities (11.0%). Suboptimal kidneys showed worse long-term overall graft survival regardless of the reasons (5-year: control vs suboptimal kidney; 88.9% vs 79.3%, P = .001 and 10-year: 73.6% vs 63.5%, P = .004). Suboptimal kidneys showed a 1.6-fold higher adjusted hazard ratio (aHR) of all-cause graft loss (95% confidence interval [CI]: 1.1-2.5, P = .025) and had the same impact as older donor age (≥ 54 years old, aHR: 1.6, 95% CI: 1.1-2.4, P = .008). CONCLUSIONS The impact of suboptimal kidney should be factored into the donor selection process.
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Affiliation(s)
- Shigeyoshi Yamanaga
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA; Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan; Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Chris E Freise
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Peter G Stock
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Angel Rosario
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Danny Fernandez
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mehdi Tavakol
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Sang-Mo Kang
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA.
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20
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Sarier M, Callioglu M, Yuksel Y, Duman E, Emek M, Usta S. Evaluation of the Renal Arteries of 2,144 Living Kidney Donors Using Computed Tomography Angiography and Comparison with Intraoperative Findings. Urol Int 2020; 104:637-640. [DOI: 10.1159/000507796] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
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21
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Demir M, Yesildal C, Yavuzsan AH, Kirecci SL, Dokucu AI. First live donor nephrectomy with abdominal tortuous aorta and two renal arteries: A renal transplantation case report. Urol Case Rep 2019; 29:101097. [PMID: 31890600 PMCID: PMC6931104 DOI: 10.1016/j.eucr.2019.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
46-year-old wife (donor) and 52-year-old husband (recipient) admitted to our clinic for kidney transplantation. CT angiography of the donor showed us there were bilateral renal double artery and a tortuous aorta that is deviated to the left side. The main artery cannot be reached by laparoscopy because of the upper level of renal artery and deviation of the aorta and an open conversion was performed. Presence of tortuous aorta with multiple renal arteries makes laparoscopic donor nephrectomy a challenging procedure even preformed by an experienced surgeon. The possibility of open conversion should always be kept in mind in these cases.
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Affiliation(s)
- Mesut Demir
- Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Cumhur Yesildal
- Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Abdullah Hizir Yavuzsan
- Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Sinan Levent Kirecci
- Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Ali Ihsan Dokucu
- Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
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22
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Broudeur L, Karam G, Chelghaf I, De Vergie S, Rigaud J, Perrouin Verbe MA, Branchereau J. Feasibility and safety of laparoscopic living donor nephrectomy in case of right kidney and multiple-renal artery kidney: a systematic review of the literature. World J Urol 2019; 38:919-927. [PMID: 31129713 DOI: 10.1007/s00345-019-02821-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/21/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To access the current status of the security and feasibility of right kidney (RK) and multiple-renal artery (MRA) laparoscopic living donor nephrectomy (LLDN) which are more challenging compared to left kidney (LK) and single renal artery (SRA) because of a shorter renal vein and more complex vascular anatomy. METHODS We did a systematic review of the literature according to the PRISMA recommendations, reporting RK or MRA donor nephrectomy performed with a laparoscopic technique compared to LK or SRA kidney LLDN. The identified and analyzed primary outcomes of interest were operating time (OT), warm ischemia time (WIT), rate of conversion and transfusion, donor length of stay (LOS), delayed graft function (DGF) and rate of graft loss (GL). RESULTS 16 comparative studies (1397 cases) of RK-LLDN and 12 comparative studies including 15 series (993 cases) of MRA-LLDN were selected. For RK-LLDN review, conversion rate was 0.8% and blood transfusion rate 0.2%, only one case of graft venous thrombosis was reported, OT was shorter in four studies and there was no any difference of DGF and GL rate compared to LK-LLDN. For MRA-LLDN review, conversion rate was 1.3% and blood transfusion rate 1.1%, OT and WIT were longer compared to SRA-LLDN, there were more ureteral complications in two studies, and no difference in terms of vascular complications and graft loss rate. CONCLUSION RK-LLDN and MRA-LLDN would be similar to LK-LLDN and SRA-LLDN in terms of feasibility and safety for the donor as well as graft function results for RK-LLDN.
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Affiliation(s)
- L Broudeur
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - G Karam
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - I Chelghaf
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - S De Vergie
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - J Rigaud
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - M A Perrouin Verbe
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France. .,Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France. .,Institut de Transplantation Urologie Néphrologie (ou ITUN), CHU Nantes, Nantes, France.
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23
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Iwami D, Hotta K, Sasaki H, Hirose T, Higuchi H, Takada Y, Iwahara N, Shinohara N. A 2-mm Cutoff Value Is Reasonable and Feasible for Vascular Reconstruction in a Kidney Allograft With Multiple Arteries. Transplant Proc 2019; 51:1317-1320. [PMID: 31027827 DOI: 10.1016/j.transproceed.2019.01.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple renal arteries are found in approximately 20% of living donor kidneys. We have been using an accessory artery cutoff diameter of 2 mm on preoperative computed tomography angiography to determine whether to sacrifice or reconstruct the artery. In this study, we assessed the validity and feasibility of this cutoff value. METHODS Living related kidney recipients from 2005 to 2013 were enrolled in this retrospective study. The diameter of the accessory artery and adverse events were evaluated. The lost parenchymal volume (%) due to vascular obstruction or branch ligation was calculated by computed tomography volumetry. RESULTS Among 128 kidney transplants, 30 donor kidneys had multiple arteries. Accessory arteries were reconstructed in 18 cases and intentionally ligated in 12 cases (mean diameter of accessory arteries, 3.10 [SD, 0.75] mm and 1.81 [SD, 0.28] mm, respectively). The mean estimated glomerular filtration rate at 1 or 12 months after transplant was not significantly different between the groups. Among reconstructed cases, 14 cases (77.8%) had good patency in the reconstructed arteries whereas the other 4 had vascular complications. The percentage of lost parenchymal volume due to ligation or occlusion of the reconstructed artery (calculated in 16 cases) was predictable with the following formula: lost volume (%) = 9.09 × diameter (mm) - 10.5 (P= .03, rs= 0.533 by Spearman rank correlation coefficient). This formula indicated that ligation of a 2-mm accessory artery leads to 7.68% loss of the renal parenchyma. CONCLUSIONS Reconstruction using a cutoff diameter of 2 mm is worth attempting in terms of the success rate and graft function. Sacrifice of a 2-mm accessory artery leads to parenchymal loss of <8%.
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Affiliation(s)
- Daiki Iwami
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Kiyohiko Hotta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hajime Sasaki
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hirose
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Haruka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Takada
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoya Iwahara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Laparoscopic procurement of single versus multiple artery kidney allografts: Meta-analysis of comparative studies. Asian J Surg 2019; 42:61-70. [DOI: 10.1016/j.asjsur.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/24/2018] [Accepted: 06/14/2018] [Indexed: 02/02/2023] Open
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Silvinato A, Bernardo WM, Santos LS. Living donor nephrectomy. Rev Assoc Med Bras (1992) 2018; 64:1061-1068. [PMID: 30569978 DOI: 10.1590/1806-9282.64.12.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. CONCLUSIONS The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
| | - Antonio Silvinato
- Author and member of the Guidelines Program of the Brazilian Medical Association, São Paulo, Brasil
| | - Wanderley M Bernardo
- Lecturer Professor of School of Medicine of USP; São Paulo, SP, Brasil.,Coordinator of the Brazilian Medical Association Guidelines Program, São Paulo, SP, Brasil
| | - Luis Sérgio Santos
- Reviewer and member of the Guidelines Program of the Brazilian Medical Association, São Paulo, Brasil
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First Case of Right Malrotated Kidney Transplantation. Transplant Proc 2018; 50:3923-3924. [DOI: 10.1016/j.transproceed.2018.02.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
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Yamanaga S, Rosario A, Fernandez D, Kobayashi T, Tavakol M, Stock PG, Kang SM. Inferior long-term graft survival after end-to-side reconstruction for two renal arteries in living donor renal transplantation. PLoS One 2018; 13:e0199629. [PMID: 29995911 PMCID: PMC6040747 DOI: 10.1371/journal.pone.0199629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/11/2018] [Indexed: 12/26/2022] Open
Abstract
Living donor kidneys with two arteries can be revascularized using various techniques depending on anatomy. We hypothesized that the revascularization technique could impact long-term outcomes. We retrospectively analyzed 1714 living donor renal transplants at our institution between 1999 and 2015. Three hundred and eleven kidneys had dual arteries, and these were categorized into 5 groups; end-to-side (n = 18), inferior epigastric artery (n = 21), direct anastomosis (n = 65), side-to-side (n = 126) and ligated (n = 81). We then compared the outcomes with that of a control group (single artery, n = 1403) using Kaplan-Meier and Cox regression analyses. Cox regression was adjusted by age, sex and race/ethnicity of donor and recipient, side of kidney, transplant period and recipient surgeon. Compared to the control group, the end-to-side group had increased all-cause graft loss (10 years: 77.2% vs 24.5%, adjusted hazard ratio [aHR] 3.02, 95% confidence interval [CI] 1.30–7.03, p = 0.010) and death-censored graft loss (10 years: 82.0% vs 55.9%, aHR 4.17, 95% CI 1.63–10.68, p = 0.003), whereas the other groups did not. Our study shows that 10-year overall survival and death-censored graft survival were significantly worse for end-to-side arterial reconstruction than for other techniques. Alternative techniques to the end-to-side method should be used for accessory arteries that require revascularization.
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Affiliation(s)
- Shigeyoshi Yamanaga
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Angel Rosario
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Danny Fernandez
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mehdi Tavakol
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Peter G. Stock
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Sang-Mo Kang
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
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Gulas E, Wysiadecki G, Szymański J, Majos A, Stefańczyk L, Topol M, Polguj M. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Arch Med Sci 2018; 14:442-453. [PMID: 29593819 PMCID: PMC5868651 DOI: 10.5114/aoms.2015.55203] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/16/2015] [Indexed: 11/17/2022] Open
Abstract
Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.
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Affiliation(s)
- Ewelina Gulas
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Jacek Szymański
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Lodz, Poland
| | | | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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Siena G, Campi R, Decaestecker K, Tuğcu V, Sahin S, Alcaraz A, Musquera M, Territo A, Gausa L, Randon C, Stockle M, Janssen M, Fornara P, Mohammed N, Guirado L, Facundo C, Doumerc N, Vignolini G, Breda A, Serni S. Robot-assisted Kidney Transplantation with Regional Hypothermia Using Grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: Results from the European Association of Urology Robotic Urology Section Working Group. Eur Urol Focus 2018; 4:175-184. [DOI: 10.1016/j.euf.2018.07.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/25/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
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Ureteral Complications in Kidney Transplantation: Analysis and Management of 853 Consecutive Laparoscopic Living-Donor Nephrectomies in a Single Center. Transplant Proc 2017; 48:2684-2688. [PMID: 27788801 DOI: 10.1016/j.transproceed.2016.06.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/09/2016] [Accepted: 06/06/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND We report the incidence and nature of ureteral and surgical complications in our series of 853 consecutive living-donor renal transplants after laparoscopic living-donor nephrectomy. The aim of this study was to analyze the therapeutic approaches to ureteral complications in kidney transplantations and their relationship with recipient outcome. METHODS The medical records of patients who underwent kidney transplantation from 2000 to 2014 were reviewed retrospectively. After the donor nephrectomies were performed with the use of laparoscopic, hand-assisted laparoscopic, and vesico-ureteral anastomosis, the recipient's ureteral complications were classified according to the mechanism and site of urinary tract involvement: anastomosis stricture, anastomosis leakage, vesico-ureteral reflux, and urolithiasis. RESULTS Among the 853 cases of kidney transplantation, ureteral complications occurred in 66 patients (7.73%). The most common complication was urinary tract infection caused by vesico-ureteral reflux (n = 24, 2.81%), which was managed with by means of sub-ureteral polydimethylsiloxane injection. The second most common complication was the anastomosis site stricture (n = 23, 2.69%), which was treated by means of ureteral re-implantation or percutaneous nephrostomy. Anastomosis site leakage occurred in 11 patients (1.28%) and was managed by percutaneous nephrostomy with double-J stenting and drainage or ureteral re-implantation. Urolithiasis occurred in 8 patients (0.93%). CONCLUSIONS There was an 8% rate of recipient ureteral complications at our institution. Of the 66 patients, 46 (5.4%) required surgical repair. The remaining 20 patients with ureteral complications were treated with conservative care or minimally invasive procedures. The keys to successful management of these problems are early diagnosis and prompt reconstruction whenever possible. Most ureteral complications are easily managed with a successful outcome with early intervention.
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Nakamura Y, Kihara Y, Iwamoto H, Ozawa Y, Sano T, Tomita K, Yokoyama T, Konno O, Ueno T, Kawachi S. A Novel Assessment of Vascular Regions Using an Intraoperative Near-Infrared Fluorescence. Transplant Proc 2017; 48:710-5. [PMID: 27234719 DOI: 10.1016/j.transproceed.2015.12.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The risk of complications and transplant renal function increases in multiple arterial renal transplantations compared with single arterial renal transplantations. Even when multiple arteries are involved, with the introduction of laparoscopic nephrectomy, I mainly choose the left side kidney. Therefore, the number of renal artery reconstructions is increasing, and simultaneous imaging of arterial rebuilding during the donor nephrectomy is important. MATERIAL Between 2006 and 2015, we performed 132 living donor kidney transplantations at our center and analyzed 32 cases that were diagnosed pre- and intraoperatively. METHOD We compared the single renal artery (SRA) and multiple renal arteries (MRA) groups and analyzed the number of renal arteries, reconstruction methods, donor and recipient ages, sex, total ischemic times, and 1-month serum creatinine values. RESULT In the MRA and SRA groups, the average recipient age was 52.3 and 47.0 years, respectively, while the average donor age was 52.9 and 53.1 years, respectively. In SRA and MRA groups, total ischemic time (TIT) was 96.1 and 143.6 min (P < .01). Serum creatinine level 1 month post-transplantation was 1.54 and 1.25, respectively (P < .001). Here we experienced 12 cases of living renal donor nephrectomy with multiple vessels in which the vascular supply territory was first assessed in April 2013 using an intraoperative near-infrared fluorescence camera system. In addition, regarding TIT, it is possible to shorten surgery by using individual anastomosis and ligation. CONCLUSION By managing multiple donors; arteries by nephrectomy, it is possible to improve kidney transplantation results.
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Affiliation(s)
- Y Nakamura
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
| | - Y Kihara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - H Iwamoto
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Y Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - K Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Yokoyama
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - O Konno
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Ueno
- Division of Acute and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - S Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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Hiramitsu T, Okada M, Futamura K, Yamamoto T, Tsujita M, Goto N, Narumi S, Watarai Y. Impact of grafting using thin upper pole artery ligation on living-donor adult kidney transplantation: The STROBE study. Medicine (Baltimore) 2016; 95:e5188. [PMID: 27759654 PMCID: PMC5079338 DOI: 10.1097/md.0000000000005188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the impact of grafting using thin upper pole artery ligation for living-donor adult kidney transplantation. Few reports have examined the safety of thin upper pole artery ligation.Between January 2008 and May 2015, 613 consecutive living-donor adult kidney transplantations were performed. We excluded 21 recipients who experienced graft loss due to factors that were unrelated to surgical complications and 3 recipients with grafts treated with arterial reconstruction and thin upper pole artery ligation for 3 arteries. We included 439 kidney grafts with single arteries (Single Artery Group), 123 with reconstructed arteries (Arterial Reconstruction Group) and 27 with ligated thin upper pole arteries (Arterial Ligation Group) in this retrospective cohort study. To evaluate the safety of thin upper pole artery ligation, we compared the Arterial Ligation Group with the Single Artery and Arterial Reconstruction groups. We evaluated the characteristics of the enrolled donors, recipients, and their grafts. Thereafter, we investigated recipients' perioperative and postoperative estimated glomerular filtration rate (eGFR) and complication rates.Significant differences among the 3 groups were identified for donor sex and endoscopic nephrectomy rates. Recipient eGFR and the complication rates were adjusted according to these factors. The perioperative and postoperative eGFR of recipients did not differ significantly in the Arterial Reconstruction and Single Artery groups with low complication rates.Thin upper pole artery ligation is a safe procedure for living-donor adult kidney transplantation and may prevent unnecessary arterial reconstruction and associated complications.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Myoken-cho, Showa-ku, Nagoya, Aichi, Japan
- Correspondence: Takahisa Hiramitsu, Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Myoken-cho, Showa-ku, Nagoya, Aichi, Japan (e-mail: )
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Lim YMJ, Han X, Raman L, Ng TK, Goh THA, Vathsala A, Tiong HY. Outcome of Living Donor Transplant Kidneys With Multiple Arteries. Transplant Proc 2016; 48:848-51. [PMID: 27234750 DOI: 10.1016/j.transproceed.2015.12.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/30/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Living donor transplantation (LDT) using kidneys with multiple arteries (MA) has previously been reported to be associated with increased complications and poorer outcomes in recipients. The objective of this study was to investigate outcomes of LDT with MA at the National University Hospital of Singapore, an institution with modest kidney transplant volumes. METHODS From 2007 to 2014, a total of 109 consecutive living donor kidney transplantations were performed. Of the nephrectomies, 91% were left sided. A total of 19 cases involved MA, of which 7 with small polar vessels (<2 mm) were ligated and 12 were revascularized. Baseline characteristics and outcomes were comparable between donor-recipient pairs with MA and single artery (SA). Both groups had equivalent induction and maintenance immunosuppressive regimens. RESULTS Mean warm ischemia time (minutes) was similar for kidneys with MA and SA (4.3 ± 3.2 vs 3.9 ± 3.2, P = .38). Operative time (minutes) in the recipients was also equivalent (P > .05) for MA and SA (158 ± 39.2 and 145 ± 57.2, respectively). The MA kidney recipients had a lower estimated glomerular filtration rate (eGFR) on postoperative day 5 compared to SA (56.6 ± 24.2 vs 74.1 ± 35.9 mL/min/1.73 m(2), P = .058). However, eGFR at 1 year was the similar for both groups (64.9 ± 16.2 vs 66.4 ± 18.1 mL/min/1.73 m(2), respectively, P = .76). Delayed graft function rates were 5.6% and 6.6% for MA and SA, respectively (P = .9). There were no surgical complications for LDT recipients within the MA group. Patient and graft survival was 100% in the MA group compared with 98% in the SA group (P > .05). CONCLUSIONS With current surgical techniques, LDT with MA can achieve equally good functional outcomes at 1 year as SA kidneys, with minimal surgical complications.
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Affiliation(s)
- Y M J Lim
- Department of Urology, National University Health System, Singapore
| | - X Han
- Department of Urology, National University Health System, Singapore
| | - L Raman
- Department of Urology, National University Health System, Singapore
| | - T K Ng
- Department of Urology, National University Health System, Singapore
| | - T H A Goh
- Department of Urology, National University Health System, Singapore
| | - A Vathsala
- Department of Urology, National University Health System, Singapore
| | - H Y Tiong
- Department of Urology, National University Health System, Singapore.
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Lafranca JA, van Bruggen M, Kimenai HJAN, Tran TCK, Terkivatan T, Betjes MGH, IJzermans JNM, Dor FJMF. Vascular Multiplicity Should Not Be a Contra-Indication for Live Kidney Donation and Transplantation. PLoS One 2016; 11:e0153460. [PMID: 27077904 PMCID: PMC4831799 DOI: 10.1371/journal.pone.0153460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Whether vascular multiplicity should be considered as contraindication and therefore 'extended donor criterion' is still under debate. METHODS Data from all live kidney donors from 2006-2013 (n = 951) was retrospectively reviewed. Vascular anatomy as imaged by MRA, CTA or other modalities was compared with intraoperative findings. Furthermore, the influence of vascular multiplicity on outcome of donors and recipients was studied. RESULTS In 237 out of 951 donors (25%), vascular multiplicity was present. CTA had the highest accuracy levels regarding vascular anatomy assessment. Regarding outcome of donors with vascular multiplicity, warm ischemia time (WIT) and skin-to-skin time were significantly longer if arterial multiplicity (AM) was present (5.1 vs. 4.0 mins and 202 vs. 178 mins). Skin-to-skin time was significantly longer, and complication rates were higher in donors with venous multiplicity (203 vs. 180 mins and 17.2% vs. 8.4%). Outcome of renal transplant recipients showed a significantly increased WIT (30 vs. 26.7 minutes), higher rate of DGF (13.9% vs. 6.9%) and lower rate of BPAR (6.9% vs. 13.9%) in patients receiving a kidney with AM compared to kidneys with singular anatomy. CONCLUSIONS We conclude that vascular multiplicity should not be a contra-indication, since it has little impact on clinical outcome in the donor as well as in renal transplant recipients.
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Affiliation(s)
- Jeffrey A. Lafranca
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark van Bruggen
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hendrikus J. A. N. Kimenai
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thi C. K. Tran
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Türkan Terkivatan
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G. H. Betjes
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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EXP CLIN TRANSPLANTExp Clin Transplant 2016; 14. [DOI: 10.6002/ect.2015.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Khalil A, Mujtaba MA, Taber TE, Yaqub MS, Goggins W, Powelson J, Sundaram C, Sharfuddin AA. Trends and outcomes in right vs. left living donor nephrectomy: an analysis of the OPTN/UNOS database of donor and recipient outcomes - should we be doing more right-sided nephrectomies? Clin Transplant 2015; 30:145-53. [DOI: 10.1111/ctr.12668] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Ali Khalil
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
| | - Muhammad A. Mujtaba
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
| | - Tim E. Taber
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
| | - Muhammad S. Yaqub
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
| | - William Goggins
- Division of Transplant Surgery; Department of Surgery; Indiana University; Indianapolis IN USA
| | - John Powelson
- Division of Transplant Surgery; Department of Surgery; Indiana University; Indianapolis IN USA
| | | | - Asif A. Sharfuddin
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
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Walther AE, Coots AC, Goebel JW, Alonso MH, Ryckman FC, Tiao GM, Nathan JD. Laparoscopic donor nephrectomy for the pediatric recipient population: Risk factors for adverse outcomes. Pediatr Transplant 2015; 19:836-43. [PMID: 26329665 DOI: 10.1111/petr.12587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
Abstract
Kidney transplantation is the optimal treatment of ESRD in children. Some studies have reported inferior outcomes in recipients of LDN allografts who are ≤ 5 yr of age. We performed a retrospective review of pediatric recipient outcomes of 110 LDN allografts at our institution and examined predictors of adverse outcomes. Subgroup analysis was performed by dividing recipients into three age categories: 0-5 yr, 6-17 yr, and ≥ 18 yr. There was no significant difference between incidences of DGF or ARE between groups. Kaplan-Meier analysis demonstrated 100% allograft survival in 0- to 5-yr-old recipients, nearly reaching statistical significance (p = 0.07) for outcome superior to that of the two older age groups. Pretransplant HD was associated with increased risk of DGF (p = 0.05). Significant risk factors for ARE were recipient weight >15 kg (p = 0.033) and multiple renal arteries (p = 0.047). Previous ARE was associated with an increased risk of allograft failure (p = 0.02). LDN is not associated with increased risk of DGF, ARE, or allograft failure in the youngest recipients. These findings support an aggressive pursuit of preemptive transplantation even in the youngest pediatric allograft recipients.
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Affiliation(s)
- Ashley E Walther
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Abigail C Coots
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jens W Goebel
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maria H Alonso
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Frederick C Ryckman
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Greg M Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jaimie D Nathan
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Hiramitsu T, Futamura K, Okada M, Yamamoto T, Tsujita M, Goto N, Narumi S, Watarai Y, Kobayashi T. Impact of Arterial Reconstruction With Recipient's Own Internal Iliac Artery for Multiple Graft Arteries on Living Donor Kidney Transplantation: Strobe Study. Medicine (Baltimore) 2015; 94:e1811. [PMID: 26512578 PMCID: PMC4985392 DOI: 10.1097/md.0000000000001811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to investigate the usefulness of arterial reconstruction using the recipient's own internal iliac artery for multiple kidney graft arteries.The safety and efficacy of various arterial reconstruction methods have been demonstrated. Although some reports have documented arterial reconstruction with the recipient's own internal iliac artery for multiple kidney graft arteries using the interposition method, usefulness of this technique has not yet been investigated compared with other arterial reconstruction methods.Between January 2008 and April 2014, 532 living donor kidney transplants in adult recipients were performed at 1 center. Of these, 389 kidney grafts had a single artery and did not need arterial reconstruction (nonarterial reconstruction group). Among the bench surgery patients, 19 kidney grafts for multiple arteries were performed using the interposition method with the recipient's own internal iliac artery (interposition group). Seventy-nine kidney grafts were performed using conjoined reconstruction (conjoined group) and 15 kidney grafts were performed using end-to-side reconstruction (end-to-side group). Total ischemic time (the period between arterial clamp and blood reperfusion), time to initial urination, perioperative and postoperative estimated glomerular filtration rate (eGFR), and complication rates between the interposition group and other 3 groups were retrospectively investigated. This study was based on the STROBE compliant.Warm ischemic time (the period between arterial clamp and beginning of the cold perfusion) of interposition group was significantly longer than that of nonarterial reconstruction group. Total ischemic time of the interposition group was significantly longer than those of other 3 groups. But time to initial urination, perioperative and postoperative eGFR, and complications were similar to other 3 groups.The interposition method was shown to be a useful standard method for multiple kidney graft arteries of living donor kidney transplantation in carefully selected recipients without calcification of the iliac arteries.
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Affiliation(s)
- Takahisa Hiramitsu
- From the Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital (TH, KF, MO, TY, MT, NG, SN, YW); and Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan (TK)
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Ooms LSS, Slagt IKB, Dor FJMF, Kimenai HJAN, Tran KTC, Betjes MGH, IJzermans JNM, Terkivatan T. Ureteral length in live donor kidney transplantation; Does size matter? Transpl Int 2015. [PMID: 26211787 DOI: 10.1111/tri.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the role of ureteral length on urological complications. Data were retrospective collected from the INEX-trial database, a RCT to compare the intravesical to the extravesical ureteroneocystostomy. Ureteral length was measured in 198 recipients and used to divide recipients into three categories based on interquartile ranges: short (≤8.5 cm), medium (8.6-10.9 cm) and long ureters (≥11 cm). Urological complications were defined as the number of percutaneous nephrostomy placements (PCN). Fifty recipients fell into the short, 98 into the medium and 50 recipients into the long ureter category. Median follow-up was 26 (range 2-45) months. There was no significant difference in number of PCN placements between the categories. There were 9 (18%) PCN placements in the short ureter category, 21 (20%) in medium ureter category and 10 (21%) in the long ureter category, P = 0.886. Risk factor analysis for gender, arterial multiplicity and type of ureteroneocystostomy showed no differences in PCN placements between the three ureteral length categories. We conclude that ureteral length alone does not seem to influence the number of urological complications.
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Affiliation(s)
- Liselotte S S Ooms
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Inez K B Slagt
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Khe T C Tran
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Türkan Terkivatan
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Song G, Jeong IG, Kim YH, Han DJ, Kim CS, Ahn H, Ahn TY, Hong B. Kidney Laterality and the Safety of Hand-assisted Live Donor Nephrectomy: Review of 1000 Consecutive Cases at a Single Center. Urology 2015; 85:1360-6. [DOI: 10.1016/j.urology.2014.12.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 12/05/2014] [Accepted: 12/12/2014] [Indexed: 10/23/2022]
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Iype S, David S, Hilliard S, Shaw A, Jamieson NV, Praseedom RK, Butler AJ, Huguet EL, Parker RA, Bradley JA, Watson CJE. When one becomes more: minimum renal artery length in laparoscopic live donor nephrectomy. Clin Transplant 2015; 29:588-93. [PMID: 25965009 DOI: 10.1111/ctr.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laparoscopic donor nephrectomy may convert short main arteries into multiple arteries, increasing the technical challenge of implantation. We evaluated our experience to identify factors predictive of multiple arteries after laparoscopic nephrectomy. METHODS All laparoscopic nephrectomies from the start of our program in November 2002 until June 2013 were studied, and preoperative imaging reviewed for donor artery length and multiplicity together with operative findings. RESULTS A total of 287 consecutive laparoscopic live donor nephrectomies (64 right and 223 left nephrectomies) were studied. Renal artery length was measured from preoperative donor magnetic resonance or computed tomography angiogram and nephrectomy performed using a laparoscopic stapling device. Nine left kidneys with a single artery (6, 7, 9, 10, 11, 12, 13, 14, and 16 mm in length) and five right kidneys with a single artery (5, 13, 15, 20, and 26 mm) on imaging resulted in multiple renal arteries at implantation. Complex renal vein anatomy was associated with multiple arteries following retrieval. CONCLUSION A main renal artery length of more than 16 mm on the left and 26 mm on the right is unlikely to result in multiple arteries to implant. The possibility of multiple arteries should be borne in mind when the donor renal artery is short.
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Affiliation(s)
- S Iype
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,Cambridge NIHR Comprehensive Biomedical Research Centre, Cambridge, UK
| | - S David
- University of Cambridge, Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - S Hilliard
- University of Cambridge, Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A Shaw
- University of Cambridge, Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - N V Jamieson
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,Cambridge NIHR Comprehensive Biomedical Research Centre, Cambridge, UK
| | - R K Praseedom
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,Cambridge NIHR Comprehensive Biomedical Research Centre, Cambridge, UK
| | - A J Butler
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,Cambridge NIHR Comprehensive Biomedical Research Centre, Cambridge, UK
| | - E L Huguet
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,Cambridge NIHR Comprehensive Biomedical Research Centre, Cambridge, UK
| | - R A Parker
- Health Services Research Unit, University of Edinburgh, Edinburgh, UK
| | - J A Bradley
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,Cambridge NIHR Comprehensive Biomedical Research Centre, Cambridge, UK
| | - C J E Watson
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,Cambridge NIHR Comprehensive Biomedical Research Centre, Cambridge, UK
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Rahnemai-Azar AA, Gilchrist BF, Kayler LK. Independent risk factors for early urologic complications after kidney transplantation. Clin Transplant 2015; 29:403-8. [PMID: 25683841 DOI: 10.1111/ctr.12530] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 01/01/2023]
Abstract
Urologic complications are the most frequent technical adverse events following kidney transplantation (KTX). We evaluated traditional and novel potential risk factors for urologic complications following KTX. Consecutive KTX recipients between December 1, 2006 and December 31, 2010 with at least six-month follow-up (n = 635) were evaluated for overall urologic complications accounting for donor, recipient, and transplant characteristics using univariate and multivariate logistic regression. Urologic complications occurred in 29 cases (4.6%) at a median of 40 d (range 1-999) post-transplantation and included 17 ureteral strictures (2.6%), five (0.8%) ureteral obstructions due to donor-derived stones or intraluminal thrombus, and seven urine leaks (1.1%). All except two complications occurred within the first year of transplantation. Risk factors for urologic complications on univariate analysis were dual KTX (p = 0.04) and renal artery multiplicity (p = 0.02). On multivariate analysis, only renal artery multiplicity remained significant (aHR 2.4, 95% confidence interval 1.1, 5.1, p = 0.02). Donation after cardiac death, non-mandatory national share kidneys, donor peak serum creatinine > 1.5 mg/dL or creatinine phosphokinase > 1000 IU/L, and donor down time were not associated with urologic complications. Our data suggest that donor artery multiplicity is an independent risk factor for urologic complications following KTX.
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Affiliation(s)
- Amir A Rahnemai-Azar
- Department of Surgery, Bronx Lebanon Hospital, Albert Einstein College of Medicine, New York, NY, USA
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Retroperitoneoscopic Donor Nephrectomy With Multiple Renal Arteries Does Not Affect Graft Survival and Ureteral Complications. Transplantation 2014; 98:1175-81. [DOI: 10.1097/tp.0000000000000326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laparoscopic living donor nephrectomy: making optimal use of donors without doing harm. Transplantation 2014; 98:1144. [PMID: 25050470 DOI: 10.1097/tp.0000000000000324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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A case of right renal artery originating from the thoracic aorta. Jpn J Radiol 2014; 32:716-20. [DOI: 10.1007/s11604-014-0360-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
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Ahmadi AR, Lafranca JA, Claessens LA, Imamdi RMS, IJzermans JNM, Betjes MGH, Dor FJMF. Shifting paradigms in eligibility criteria for live kidney donation: a systematic review. Kidney Int 2014; 87:31-45. [PMID: 24786706 DOI: 10.1038/ki.2014.118] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/06/2014] [Accepted: 02/20/2014] [Indexed: 12/11/2022]
Abstract
As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, trying to seek and establish the optimal extended criteria. Comprehensive searches were carried out in major databases until November 2013 to search for articles regarding older age, overweight and obesity, hypertension, vascular anomalies/multiplicity, nulliparous women, and minors as donors. Of the 2079 articles found, 152 fell within the scope of the review. Five major guidelines were included and reviewed. Based on the literature search, live kidney donation in older donors (up to 70 years of age) seems to be safe as outcome is comparable to younger donors. Obese donors have comparable outcome to lean donors, in short- and mid-term follow-up. Since little literature is available proving the safety of donation of hypertensive donors, caution is advised. Vascular multiplicity poses no direct danger to the donor and women of childbearing age can be safely included as donors. Although outcome after donation in minors is shown to be comparable to adult donors, they should only be considered if no other options exist. We conclude that the analyzed factors above should not be considered as absolute contraindications for donation.
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Affiliation(s)
- Ali R Ahmadi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeffrey A Lafranca
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura A Claessens
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Raoul M S Imamdi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Slagt IKB, IJzermans JNM, Visser LJ, Weimar W, Roodnat JI, Terkivatan T. Independent risk factors for urological complications after deceased donor kidney transplantation. PLoS One 2014; 9:e91211. [PMID: 24608797 PMCID: PMC3946700 DOI: 10.1371/journal.pone.0091211] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 02/09/2014] [Indexed: 02/07/2023] Open
Abstract
Urological complications after kidney transplantation are mostly related to the ureteroneocystostomy, often requiring interventions with additional costs, morbidity and mortality. Our aim was to assess risk factors for urological complications in deceased donor kidney transplantation. Between January 2000 and December 2011, 566 kidney transplantations were performed with deceased donor kidneys. Recipients were divided in a group with, and a group without urological complications, defined as the need for a percutaneous nephrostomy catheter or surgical revision of the ureteroneocystostomy. Univariate and multivariate analyses were performed. Univariate analysis showed increased number of male donors (p = 0.041), male recipients (p = 0.002), pre-emptively transplanted recipients (p = 0.007), and arterial reconstructions (p = 0.004) in the group with urological complications. Less urological complications occurred in recipients on hemodialysis (p = 0.005). More overall surgical interventions (p<0.001), surgical site infections (p = 0.042), urinary tract infections (p<0.001) and lymphoceles (p<0.001) occurred in the group with urological complications. Multivariate analysis showed that male recipients (p = 0.010) and arterial reconstructions (p = 0.019) were independent risk factors. No difference was found between both groups in patient or graft survival. In conclusion, recipient male gender and arterial reconstruction are independent risk factors for urological complications after deceased donor kidney transplantation. Nevertheless, graft and recipient survival is not different between both groups.
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Affiliation(s)
- Inez K. B. Slagt
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Laurents J. Visser
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Division of Nephrology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Joke I. Roodnat
- Department of Internal Medicine, Division of Nephrology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Türkan Terkivatan
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- * E-mail:
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Maximizing the donor pool: left versus right laparoscopic live donor nephrectomy—systematic review and meta-analysis. Int Urol Nephrol 2014; 46:1511-9. [DOI: 10.1007/s11255-014-0671-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
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49
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Hu JC, Liu CH, Treat EG, Ernest A, Veale J, Carter S, Huang KH, Blumberg JM, Schulam PG, Gritsch HA. Determinants of Laparoscopic Donor Nephrectomy Outcomes. Eur Urol 2014; 65:659-64. [DOI: 10.1016/j.eururo.2013.09.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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50
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Retrocaval Renal Artery Bifurcation Is Not a Contraindication to Laparoscopic Right Donor Nephrectomy. J Am Coll Surg 2013; 217:406-11. [DOI: 10.1016/j.jamcollsurg.2013.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 11/22/2022]
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