Corner-saving renal artery anastomosis for renal transplantation

Renal transplantation is the preferred treatment for most patients with end-stage renal disease. Postoperative vascular complications that significantly affect graft loss include stenosis and renal artery thrombosis. Our transplant team has performed 1635 procedures since 1975. Since December 2003, we have performed a corner-saving technique for the renal artery anastomoses in 183 recipients. In this study, we retrospectively analyzed the outcome data from these procedures in 43 women and 140 men of overall mean age of 31.6 years (range, 7-66 years). Graft tissue was obtained from deceased donors in 47 and from living donors in 136 recipients. The mean age of the donors was 39.8 years (range, 6-67 years). The graft renal arteries were spatulated from the posterior walls of the renal artery to provide wide anastomoses. Using this technique, a renal artery stenosis occurred at 5 months after renal transplantation in 1 recipient (0.54%). It was treated successfully with balloon angioplasty and placement of an intraluminal stent. We did not encounter any instances of renal artery thrombosis during a mean follow-up of 20.6 +/- 11.6 months (range, 1-40 months). During follow-up, 5 recipients died, and 9 returned to hemodialysis. At the time of this writing, the remaining 169 recipients (92.3%) are alive with good graft function. In conclusion, owing to its low complication rate, we believe our new corner-saving technique to be the safest way to perform a renal artery anastomosis.