MULTIPLE VERSUS SINGLE RENAL ARTERIES IMPACT ON GRAFT FUNCTION IN RENAL TRANSPLANTATION

SHAKIR SALEEM JABALI; ZANA SIDIQ M; AYAD AHMAD MOHAMMED

SHAKIR SALEEM JABALI * Assist. Professor, Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
ZANA SIDIQ M Assist. Professor, Department of Medicine, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
AYAD AHMAD MOHAMMED Assist. Professor, Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region,

Keywords: Graft function, Multiple renal arteries, Renal transplantation, Single renal artery

Abstract

https://doi.org/10.31386/dmj.2020.14.2.6

Background: The incidence of end-stage renal disease is increasing worldwide. Kidney transplantation is the most effective single procedure for such patients. The presence of multiple renal arteries is grouped among one of the anatomical difficulties that are faced during renal transplantation.

Patients and methods: Patients who underwent renal transplantation over a period of 4 years were included in this study. The aim of this study was to analyze the incidence of complications among recipients of renal transplantation with a single renal artery and multiple arteries. The anatomy of the renal vasculature was determined by magnetic resonance arteriography.

Results: The study included 199 patients, 158 with multiple renal arteries, and 41 patients with single renal artery. There was no significant difference in donor age and the cause of renal failure between both groups (P values were 0.841 and 0.343), respectively. Idiopathic renal failure and diabetes mellitus were among the commonest caused of renal failure. There was a significant difference in the cold ischemia time between both study groups (P= <0.001), being higher in renal transplant recipients of kidneys with multiple renal arteries. In contrast, the hot ischemia time showed no significant difference. There was a very significant correlation regarding the development of complications between both groups (P=0.001). Urinary and vascular complications were commoner in patients with multiple renal arteries. The rate of vascular complications was higher in renal transplant recipients of kidneys with multiple renal arteries with no statistical significance between both study groups (P=0.197), while the urinary showed a very high significant correlation (P=0.001). Lymphatic leakage was more prevalent in those with a single renal artery (P=0.001). There was no difference regarding the graft rejection between both study groups. Two patients died, one from myocardial infarction and acute liver failure.

Conclusion: Renal transplantation for multiple renal arteries is safe and had no negative impact on the graft outcome with higher vascular complication rates.

Downloads

Download data is not yet available.

References

1. Ali R Ahmadi, Jeffrey A Lafranca, Laura A Claessens, Raoul MS Imamdi, Jan NM IJzermans, Michiel GH Betjes, et al. Shifting paradigms in eligibility criteria for live kidney donation: a systematic review. Kidney International. 2015;87(1):31-45.
2. Eduardo Mazzucchi, Auro A Souza, Willian C Nahas, Ioannis M Antonopoulos, Affonso C Piovesan, Sami Arap. Surgical complications after renal transplantation in grafts with multiple arteries. International braz j urol. 2005;31(2):125-30.
3. Hafiz Shahzad Ashraf, Imran Hussain, Amjad Ali Siddiqui, M Nasir Ibrahim, Mohammadf Usman Khan. The outcome of living-related kidney transplantation with multiple renal arteries. Saudi Journal of Kidney Diseases and Transplantation. 2013; 24(3): 615.
4. Marcel Zorgdrager, Christina Krikke, Sybrand H Hofker, HG Leuvenink, Robert A Pol. Multiple renal arteries in kidney transplantation: a systematic review and meta-analysis. Ann Transplant. 2016;21(469):10.12659.
5. Sang Seok Choi, Song Cheol Kim, Duck Jong Han. Clinical outcome of microsurgical multiple renal artery reconstruction in renal transplantation. J Korean Soc Transplant. 1997; 11(1): 81.
6. Koosha Kamali, Mohammad Amin Abbasi, Alireza Ani, Mohammad Ali Zargar, Hossein Shahrokh. Renal transplantation in allografts with multiple versus single renal arteries. Saudi Journal of Kidney Diseases and Transplantation. 2012;23(2):246.
7. Afshari Ali Taghizadeh, Fallah Mohamad Reza Mohammadi, Mansour Alizadeh, Khadijeh Makhdoomi, Ezatollah Rahimi, Sara Vossoghian. Outcome of kidney transplantation from living donors with multiple renal arteries versus single renal artery. Iran J Kidney Dis. 2016;10(2):85-90.
8. Ibrahim Al-Oraifi, Mansour Tawfeeq, Hamad Al-Hellow, Mohammed S Al-Qahtani, Meteb M Al-Bugami, Abdulwahab Al-Shahrani, et al. Laparoscopic donor nephrectomy of dual renal artery kidneys: single center experience. Chirurgia (Bucur). 2017; 112(2): 124-129.
9. AM Harraz, AA Shokeir, SA Soliman, AS El-Hefnawy, MM Kamal, I Shalaby, et al., 'Fate of accessory renal arteries in grafts with multiple renal arteries during live-donor renal allo-transplantation', in Transplantation proceedings (Elsevier, 2013), pp. 1232-1236.
10. Marcel Zorgdrager, Christina Krikke, Sybrand H Hofker, HG Leuvenink, Robert A Pol. Multiple renal arteries in kidney transplantation: a systematic review and meta-analysis. Ann Transplant. 2016; 21:469-78.
11. A Kocot, M Giessing, 'Increasing the Donor and Recipient Pool—Expanded Criteria in Living Kidney Donors', in Transplantation proceedings (Elsevier, 2013), pp. 1245-1247.
Transplantation Proceedings. 2013; 45(3): 1245-1247.
12. Reza Saidi, Tatsuo Kawai, Peter Kennealey, Georgios Tsouflas, Nahel Elias, Martin Hertl, et al. Living donor kidney transplantation with multiple arteries: recent increase in modern era of laparoscopic donor nephrectomy. Archives of Surgery. 2009; 144(5): 472-475.
13. Enrico Benedetti, Christoph Troppmann, Kristen Gillingham, DE Sutherland, William D Payne, David L Dunn, et al. Short-and long-term outcomes of kidney transplants with multiple renal arteries. Annals of surgery. 1995; 221(4): 406.
14. Bedeir Ali-El-Dein, Yasser Osman, Ahmed A Shokeir, Ahmed B Shehab El-Dein, Hussein Sheashaa, Mohamed A Ghoneim. Multiple arteries in live donor renal transplantation: surgical aspects and outcomes. The Journal of urology. 2003; 169(6): 2013-7.
15. S Vaccarisi, E Bonaiuto, N Spadafora, A Garrini, V Crocco, M Cannistra, et al., 'Complications and graft survival in kidney transplants with vascular variants: our experience and literature review', in Transplantation proceedings (Elsevier, 2013), pp. 2663-2665.
16. Hasan Bakirtas, Necmettin Guvence, Muzaffer Eroglu, Murat Ure, H Ugur Ozok, Irfan Karabulut, et al. Surgical approach to cases with multiple renal arteries in renal transplantation. Urologia internationalis. 2006; 76(2): 169-172.
17. K Chabchoub, MN Mhiri, A Bahloul, S Fakhfakh, I Ben Hmida, M Hadj Slimen, et al., 'Does kidney transplantation with multiple arteries affect graft survival?', in Transplantation proceedings (Elsevier, 2011), pp. 3423-3425.
18. Fernando Meyer, Sandro A Nichele, Ari Adamy, Luiz Sergio Santos, Christiano Machado. Early outcomes of laparoscopic donor nephrectomy with multiple renal arteries. International braz j urol. 2012; 38(4): 496-503.
19. Jennifer E Keller, Charles J Dolce, Daniel Griffin, B Todd Heniford, Kent W Kercher. Maximizing the donor pool: use of right kidneys and kidneys with multiple arteries for live donor transplantation. Surgical endoscopy. 2009; 23(10): 2327.
20. J Hellegering, J Visser, HJ Kloke, FCH D'Ancona, AJ Hoitsma, JA Van Der Vliet, et al., 'Deleterious influence of prolonged warm ischemia in living donor kidney transplantation', in Transplantation proceedings (Elsevier, 2012), pp. 1222-1226.
21. JK Hwang, SD Kim, SC Park, BS Choi, JI Kim, CW Yang, et al., 'The long-term outcomes of transplantation of kidneys with multiple renal arteries', in Transplantation proceedings (Elsevier, 2010), pp. 4053-7.
22. J Douglas Briggs. Causes of death after renal transplantation. Nephrology Dialysis Transplantation. 2001; 16(8): 1545-1549.