Renal transplantation using live donors with vascular anomalies: a salvageable surgical challenge

Renal transplantation is an established mode of management for patients with end-stage renal disease (ESRD). In India, majority of the patients with ESRD depend upon live donors for renal transplantation and renal vascular anomalies are commonly seen in these potential donors. We present our experience in renal transplantation using donors with vascular anomalies. During the period between 2001 and 2004, we performed 36 live related donor renal transplantations. All study patients had only one donor each, with compatible blood group. Ten of the donors had vascular anomalies. Three had bilateral double arteries, one had double left and single right renal artery, one had bilateral triple arteries, one had triple arteries on left and double arteries on right side, of which one had early branching, two had bilateral early branching of arteries, and two other cases had double renal veins. Open donor nephrectomy was performed in all the cases. End-to-side anastomosis with external iliac vein and artery of the recipient was performed by the parachuting technique. Eight kidneys had immediate diuresis after transplantation. In two kidneys, diuresis started 2-3 hours after administration of 120 mg of furosemide. All patients had serum creatinine ranging between 0.9 and 1.8 mg/dl by the 10th post-operative day. Follow-up of these cases have varied from one month to two years. In the current scenario, multiple arteries in the donor are no longer considered relative contraindications for renal transplantation. With good surgical skill and experience in bench surgery, all such donors can be accepted. Use of external iliac artery for anastomosis with the technique of parachuting makes the procedure easy and safe.