Technical problems in living donor transplantation

Area of Science:

• Nephrology
• Transplant Surgery
• Vascular Surgery

Background:

• Graft survival in kidney transplantation can be compromised by arterial abnormalities in donor kidneys.
• Living donor (LD) kidney transplants are susceptible to issues related to multiple renal arteries or renovascular disease.

Purpose of the Study:

• To evaluate the outcomes of living donor kidney transplants based on graft arterial anatomy and revascularization techniques.
• To assess the impact of microsurgical reconstruction on graft survival in the presence of arterial abnormalities.

Main Methods:

• A series of 261 living donor kidney transplants were classified into three groups based on arterial anatomy and reconstruction methods.
• Group I: Single healthy renal artery. Group II: Multiple arteries reconstructed intracorporeally. Group III: Diseased artery or multiple arteries reconstructed ex vivo (bench reconstruction).

Main Results:

• One- and 3-year graft survival rates were 91% and 87% (Group I), 82% and 82% (Group II), and 100% and 100% (Group III).
• A recent series of 53 LD transplants with aggressive microsurgical bench reconstruction achieved 100% 3-year graft survival, even with diseased single arteries.

Conclusions:

• Microsurgical bench reconstruction is a highly effective technique for managing living donor kidneys with arterial abnormalities.
• Aggressive reconstruction strategies can lead to excellent long-term graft survival in kidney transplantation, overcoming challenges posed by donor kidney vascular conditions.