Triple V-plasty: Novel Renovascular Reconstruction Technique in Live-Donor Transplantation

Donor renovascular anomalies, including multiplicity, length and caliber of blood vessels, could hinder renal transplantation, especially from live-donors. However, meticulous back-bench vascular reconstruction ascertaining orientation and patency of individual vessels can be effective in utilization of renal grafts with multiple renal arteries, helping to expand the pool of live-donors.

Sequential v-plasty of individual donor renal arteries using fine, non-absorbable, monofilament (7-0 or 8-0 Prolene) suture in an uninterrupted fashion enables creation of a single, wide ostium for anastomosis with the target, inflow recipient (usually external or common iliac) artery. Additionally, entwined donor hilar renovasculature may necessitate incisional separation and re-anastomosis of a bifid vein for proper renovascular orientation following graft implantation in the recipient.

Application of never-before described ex vivo renovascular reconstruction led to live-donor renal transplantation between two pairs of donor-recipient through the National Kidney Registry with successful long-term outcomes.