Introduction and Objectives
12 years transplant experience, using normal and abnormal renal pedicle, preoperative evaluation and special anastomotic techniques represented the aim of this study.
Material and Methods
From June 1997 until May 2009, 1000 renal transplantations (799 living and 201 cadaver, 949 adults and 51 pediatric transplants) with an average of 83 /year (116 in 2007), were performed in our center. General preoperative evaluation, immunological and vascular anatomy study and standard minimal lombotomy nephrectomy were performed in all living donor transplant. 310 cases (31%) had vascular graft anomalies, 185 abnormal arteries and 125 abnormal veins.
No major complications appeared in 799 nephrectomies. Minor complications were: renal artery spasm, bleeding, minor respiratory complication, pneumothorax, illeus, bladder voiding problems, UTI. Long-term complications were: persistent wound pain, parestezia and wound hernia. Quality of life after surgery was assessed using SF 36 Health Survey Test and it was normal. Surgical approach to vascular anomalies were: double T-T anastomosis – 111 cases, T-L anastomosis – 10 cases (cadaver donors), combined anastomosis T-T and T-L – 3 cases; single trunk made by two branches – 31 cases and we used the epigastric artery in 4 cases. Minor aberrant vessels were excluded in 26 cases, feeding a minor area of parenchyma. Cava patch was used in 41 cases (21 from cadaver donors). Abnormal venous drainage was managed by classical T-L anastomosis to the external iliac vein.
Renal pedicle assessment, general and immunological evaluation, represented a must. No major complication appeared in living donor nephrectomy, mortality was 0. It respects in our center the international accepted morbidity. Vascular renal graft anomalies were discovered in 31% but transplantation was performed due to special anastomotic techniques which did not significantly increase the ischemia time and vascular complications. Accepting non optimal vascular donor, number of renal transplants could increase with 30%.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.