Renal transplantation combined with aortofemoral bypass using a fresh arterial allograft

Aortoiliac atherosclerosis is frequently encountered in renal failure patients waiting for renal transplantation. Staged or simultaneous surgical repair of aortoiliac lesions with renal transplantation is possible at reasonable risk. Arterial reconstruction is most commonly performed using an artificial prosthesis. Another option is the use of a fresh or preserved arterial allograft. In our institute, about 180 cadaveric transplantations are performed each year. Over the past 2 years, three patients with chronic renal failure and obliterative disease of the abdominal aorta and iliac arteries underwent aortofemoral bypass using a fresh arterial allograft combined with kidney transplantation from the same donor. The procedures as well as the postoperative course were uneventful. There was an immediate development of function of the renal transplant. Combined arterial reconstruction and transplantation, managing both conditions at a time, is convenient for the patient mainly because it means undergoing only one general anesthesia during one hospitalization. Moreover, the risk of infection of the vascular prosthesis is somewhat reduced. Disadvantages are that the availability of the arterial allograft is dependent on a suitable donor and the limited body of experience with the behavior of the arterial allograft in patients with chronic immunosuppression.