Graft and patient outcomes among recipients of renal grafts with multiple arteries

Anastomosis of multiple renal arteries in living donor kidney transplantation is technically demanding. Previously this condition was considered a relative contraindication to use of the donor, due to an increased risk of vascular and urologic complications. We conducted this retrospective study to determine the prevalence of multiple renal arteries in kidney transplants and their relation to graft and patient survival acute tubular necrosis, as well as vascular and urologic complications for comparison with the outcomes of recipients of single-artery grafts. Among the 1425 patients who underwent renal transplantation at our center, between November 1975 and March 2003 the present analysis concerned the most recent 1095 recipients. Seventy-nine (7.2%) cases required multiple-artery anastomoses (group I) and 1016 (92.8%) a single-artery anastomosis (group II). There were no significant differences between groups I and II with respect to creatinine clearance at 1 year, cold ischemia time at 1 year, or serum creatinine values at 1, 2 or 5 years (P <.05 for all). There were also no significant differences between the groups with respect to rate of posttransplantation hypertension (P =.67), acute tubular necrosis (P =.55), or number of acute rejection episodes (P =.34). The respective graft survival rates at 1 and 5 years posttransplantation were 95.1% and 73.2% in group I and 95.0% and 79% in group II. The corresponding patient survival rates were 95% and 88% for group I and 97.1% and 83.1% for group II. These findings indicate that kidney grafts with multiple arteries may be used with excellent results.