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Methylene blue usage for determining accessory artery ligation in donor kidneys
Yang Li1, Yajun Song1, Wengang Hu1
1Department of Urology, The Second Affiliated Hospital of the Army Medical University, China.
Insights
Methylene blue (MB) perfusion effectively guides accessory artery ligation in kidney donors, preserving renal function post-transplant without increasing complications. This technique aids surgical decisions for dual arteries.
Area of Science:
- Nephrology
- Transplant Surgery
- Vascular Surgery
Background:
- Accessory renal arteries in donor kidneys present a surgical challenge, requiring decisions on ligation versus preservation.
- Standard methods for assessing accessory arteries may not optimally preserve renal function.
Purpose of the Study:
- To evaluate the efficacy of methylene blue (MB) perfusion for determining accessory renal artery management in living-related donor kidney transplantation.
- To compare MB perfusion with conventional ligation methods regarding surgical outcomes and renal function.
Main Methods:
- A comparative study of 43 living-related donor kidneys with dual arteries.
- Methylene blue (MB) perfusion was used in 19 cases to assess accessory artery contribution (<10% ligated).
- Conventional ligation (diameter <2mm) was used in 24 cases; outcomes were compared.
Main Results:
- Successful kidney transplantation in all patients.
- Methylene blue (MB) group showed longer back-table surgical time but significantly lower serum creatinine 1 month post-operation.
- No significant differences in Doppler ultrasonography index or postoperative complications between groups.
Conclusions:
- Methylene blue (MB) perfusion is an effective technique for managing accessory renal arteries in donor kidneys.
- This method aids in preserving renal function post-transplantation without increasing complications.
- MB perfusion offers a valuable tool for surgical decision-making in kidney donors with dual arteries.
Abstract:
Objectives. We present a technique for determining whether to ligate or preserve accessory arteries in donor kidneys before implantation. Methods. Forty-three living-related donor kidneys in patients from January 2014 to February 2018 at our institution were included, all of which had dual arteries without the same stem. Among them, 19 cases of accessory arterial blood supply were evaluated using methylene blue (MB) perfusion, and accessory arteries supplying less than 10% of the total MB perfusion volume were ligated. The other 24 cases were assessed using a conventional method in which arteries with diameters less than 2 mm were ligated. The back-table surgical time, Doppler ultrasonography index, renal function and complications were compared between the 2 groups. Results. All patients underwent successful kidney transplantation. The back-table surgical time in the MB group was longer than that in the conventional group (42.70 ± 4.70 min vs 34.64 ± 5.30 min, P < .05). The serum creatinine level in the MB group was significantly lower than that in the conventional group 1 month after the operation (103.15 ± 19.26 μmol/L vs 119.17 ± 28.32 μmol/L, P < .05). No differences in the Doppler ultrasonography index or postoperative complications were noted. Conclusions. MB perfusion provides an easy and effective method to make decisions regarding arterial ligation and helps preserve renal function without increasing the number of complications after transplantation.
