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A Nomogram Predicts the Need for Internal Iliac Vein Dissection During Renal Transplantation: A Multicenter
Daisuke Yamada1, Yuki Nakamura2, Yasuo Ishii3
1Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Hemodialysis & Apheresis, The University of Tokyo Hospital, Tokyo, Japan.
Transplantation Proceedings
|June 18, 2026
Summary
A new nomogram predicts the need for internal iliac vein dissection (IIVD) in kidney transplants, reducing bleeding risks. This tool aids surgical planning for safer living-donor renal transplantation.
Area of Science:
- Nephrology
- Transplant Surgery
- Vascular Surgery
Background:
- Internal iliac vein dissection (IIVD) is crucial for renal transplant anastomosis but carries significant bleeding risks.
- Currently, no established method exists to preoperatively determine the necessity of IIVD during renal transplantation.
Purpose of the Study:
- To develop a preoperative predictive nomogram for assessing the need for IIVD in living-donor renal transplantation.
- Enhance surgical safety and planning by identifying high-risk cases requiring IIVD.
Main Methods:
- Retrospective analysis of 500 living-donor renal transplant cases (2009-2024) from four institutions.
- Utilized recipient anatomical factors and donor kidney characteristics as key preoperative variables.
- Employed step-down multiple logistic regression for variable selection, avoiding multicollinearity.
Main Results:
- A nomogram was developed incorporating caudal internal iliac vein branch, iliopsoas muscle shallowness, pelvic laterality, kidney thickness, and kidney laterality.
- The nomogram demonstrated strong predictive accuracy with a C-index of 0.79.
- Internal validation confirmed robustness, with an optimism-corrected C-index of 0.79 and minimal overfitting (intercept 0.03, slope 0.95).
Conclusions:
- The developed nomogram effectively assesses the necessity of IIVD for renal transplantation.
- Facilitates improved surgical planning and intraoperative decision-making.
- Contributes to enhanced safety in living-donor kidney transplantation procedures.
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