Surgery for aortoiliac aneurysms in kidney transplant recipients

With the increase of long-term survivors following renal transplantation, aorto-iliac aneurysms requiring surgical management may be encountered more often. Our experience with temporary shunts for renal transplant protection during aorto-iliac aneurysm repair is presented along with a literature review of all cases on the subject. Three male patients with a median age of 56 (range 50-61) years were operated on for a dissecting aneurysm of the common iliac artery in one, respectively abdominal aortic aneurysm in the two remaining patients. All patients had impaired transplant function preoperatively with a median serum creatinine level of 167 (range 134-202) micromol/L and a median blood urea nitrogen concentration of 15 (range 9-23) pmol/L. The intra- and postoperative course was uneventful in all patients. Median postoperative serum creatinine level and blood urea nitrogen concentration were 135 (range 123-151) micromol/L and 10 (range 9-11) pmol/L, respectively. Aorto-iliac surgery in renal transplant recipients can be performed without transplant protection. However, in patients with a deteriorated transplant function or if a prolonged aortic cross-clamp time is anticipated, renal allograft protection measures may be beneficial to prevent possible ischemic damage.