Introduction and Objectives
The aim of this study was to evaluate one week renal graft function consecutive to additional arterial and venous reconstruction and special anastomotic techniques during renal transplantation.
Material and Methods
12 years transplant experience (June1997 – May 2009) was assessed considering 1000 renal transplantations (799 living and 201 cadaver, 949 adults and 51 pediatric) with an average of 83/year (116 in 2007). In all cases, general preoperative evaluation, immunological and vascular anatomy study was performed. 310 cases (31%) had vascular graft anomalies, 185 abnormal arteries and 125 abnormal veins.
Results
Special anastomotic and reconstruction techniques were used as followed: double T-T anastomosis – 111 cases, T-L anastomosis – 10 cases (cadaver donors), combined anastomosis – 3 cases; single trunk made by two branches – 31 cases and we used the epigastric artery for small branches in 4 cases. Minor aberrant vessels were excluded, feeding a minor area of parenchyma. Cava patch and venous reconstruction were used in 41 cases (21 from cadaver donors). Abnormal venous drainage was managed by classical T-L anastomosis to the external iliac vein. One week vascular graft failure occurred in 1.4% cases – one arterial reconstructed graft (0.6%) and one venous reconstructed pedicle (0.8%), proving a reasonable result.
Conclusions
Vascular anomalies of renal pedicle were founded in 31% but transplantation was performed due to special reconstruction and anastomotic techniques. Arterial and venous reconstruction combined with special anastomotic procedures did not increase the risk of early graft failure. One week graft function remained in very good condition. Accepting the borderline vascular donor, the number of transplantation could increase with 30%.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
