Microvascular management of multiple renal arteries in transplantation

We transplanted 8 kidneys with multiple vessels into 8 recipients using microvascular techniques to reconstruct renal arteries. Three living related combinations underwent implantation of small polar vessels (end-to-side) into the main renal artery and 1 underwent conjoined (side-to-side) anastomosis of 2 equal-sized renal arteries to form a common ostium. Additional techniques were used to manage 4 cadaver kidneys with multiple renal vessels. These included anastomosis of the lower pole artery to the inferior epigastric artery, end-to-end reanastomosis of the severed branch renal artery, separate anastomoses of 2 renal arteries to 2 branches of the hypogastric artery, and placement of 2 pediatric cadaver kidneys en bloc by anastomosis of the infrahilar aorta into the external iliac artery, and anastomosis of the infrahilar vena cava to the external iliac vein. Vascular patency (confirmed by angiography) was uniform for all anastomotic vessels. No hypertensive problems developed. In 2 cases ureteral leakage occurred, which leads us to advise caution when contemplating intrahilar vascular reconstruction of short left multiple renal arteries. Recent advances in technology of microvascular surgery have enabled dependable reconstruction of multiple renal vessels in living related and cadaver donor kidneys.