Cavoli, Gioacchino Li; Matranga, Saverio; Amato, Antonio; Carollo, Camillo; Zagarrigo, Carmela; Servillo, Franca; Cavoli, Tancredi Vincenzo Li; Tralongo, Angelo
Department of Nephrology, Dialysis and Renal Transplant, Civico Hospital, Palermo, Italy
Corresponding author: Dr. Gioacchino Li Cavoli, Department of Nephrology, Dialysis and Renal Transplant, Civico Hospital, Palermo, Italy. E-mail: [email protected]
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To the Editor,
The arterial vascularization of the kidneys is quite variable. Except the main renal artery, one or more additional renal arteries are the commonest arterial anatomical variation of the kidneys, and the influence of multiple renal arteries (MRA) in the renal transplant is not well established. Contradictory results have been reported if the use of kidney allografts with MRA adversely affects posttransplant graft and patient outcomes or increases the incidence of vascular and urologic complications compared with the use of grafts with a single renal artery (SRA). In the meta-analysis of Zorgdrager, analyzing a total of 18,289 patients, the recipients of an MRA graft showed a significantly higher incidence of vascular complications compared to those who received an SRA graft; the incidence of urological complications was also higher in patients who received an MRA graft, 5.5% vs. 5% in SRA grafts; no significant differences were observed in the 5-year graft survival and 1- and 5-year patient survival rates. The authors concluded that MRA grafts were associated with a higher risk of complication and delayed graft function but had comparable long-term outcomes for graft and patient survival. Bessede et al, reviewing 3189 renal transplants performed in France in the period of 1971–2010, identifies the presence of MRA graft as a risk factor of arterial thrombosis. Ghods, among 689 renal transplants in Iran, found the presence of MRA as a predictor of delayed graft function. Ashraf, in 33 live-related kidney transplants with MRA performed from 2006 to 2010 in Pakistan, did not find a significant difference in the warm ischemia with 72 grafts with SRA. He concluded that kidney transplantation using grafts with MRA is equally safe as using grafts with SRA regarding vascular, urological complications, and patient and graft survival. Fitzpatrick among 106 renal transplants with MRA in the period of 2004–2014 in the UK, reported comparable complication rates with SRA grafts. MRA presents a technical challenge. Various techniques for arterial reconstruction in cases of MRA grafts were reported. In the bench reconstruction of MRA, it should be used the technique that best fits a particular situation and that the individual transplant surgeon feels most comfortable. In our experience (Figure 1), the presence of MRA with or without multiple anastomoses does not increase the risk of vascular or urological complications. According to current literature, we believe that renal transplant with MRA grafts is a safe procedure with no difference in long-term outcomes with SRA grafts.
Conflict of interest:
1. Zorgdrager M, Krikke C, Hofker SH, Leuvenink HG, Pol RA. Multiple Renal Arteries in kidney transplantation: A systematic review and meta-analysis. Ann Transplant 2016;21:469–78
2. Bessede T, Droupy S, Hammoudi Y, et al. Surgical prevention and management of vascular complications of kidney transplantation. Transpl Int 2012;25:994–1001
3. Ghods AJ, Savaj S, Abbasi M, Heidari H, Rokhsatyazdi H. The incidence and risk factors of delayed graft function in 689 consecutive living unrelated donor renal transplantation. Transplant Proc 2007;39:846–7
4. Ashraf HS, Hussain I, Siddiqui AA, Ibrahim MN, Khan MU. The outcome of living related kidney transplantation with multiple renal arteries. Saudi J Kidney Dis Transpl 2013;24: 615–9
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5. Fitzpatrick J, Chmelo J, Nambiar A, et al. Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels. Urol Ann 2020;12:266–70