Multiple Renal Arteries in Renal Transplantation: A Systematic Review and Meta-Analysis

Kidney transplants are a technically challenging but life-saving surgery for those living with end-stage renal disease. This meta-analysis aims to identify the complications and outcomes associated with the use of renal transplants with multiple renal arteries (MRA) when compared to single renal arteries (SRA).

A systematic literature search was conducted for all relevant studies between 1995 and 2022. PRISMA guidelines were used, with 41 studies, totalling 26 342 patients. The protocol was registered on PROSPERO as registry number CRD42023385693. Risk of bias was measured using the ROBINS-I tool.

Live-donor graft survival at 1 year and 5 years was significantly lower in the MRA group (93.8% vs. 95.3%, p = 0.003); (90.8% vs. 92.5%, p = 0.05). Total complication rates were significantly higher in the MRA group for live donors (11.4% vs. 10.5%, p < 0.007) and deceased donors (17.6% vs. 11.3%, p < 0.0001). Vascular complication rates from live donors and deceased donors both favoured SRA (4.1% vs. 3.6%, p < 0.0001); (11.3% vs. 7.8%, p < 0.007). There was no significant difference in 1 year eGFR or DGF rates after sensitivity analysis. Live-donor patient survival at 1 year favoured the MRA group (94.6% vs. 91%, p = 0.05).

MRA grafts present additional technical challenges and increased surgical risk. However, with intensifying demand on transplantation waiting lists, MRA grafts should be considered based on patient/donor and anatomical factors. MRA grafts have comparable graft and patient survival to SRA grafts despite poorer functionality. Many of these risks are diminished with living donor MRA which should no longer be a relative contraindication for transplantation.