Living donor kidney transplantation with multiple renal arteries in the laparoscopic era.
ABSTRACT To compare the postoperative complications and survival metrics after multiple renal arteries (MRA) and single renal artery (SRA) laparoscopically procured living donor kidney transplantation (LLDKT). MRA are the most frequently encountered anatomic variation during kidney transplantation. The long-term outcomes of LLDKT with MRA are not well characterized.
A retrospective review of our institution's LLDKT database was performed. All surgeries were performed at a single tertiary care academic center between June 1999 and September 2008. Patients were divided into 2 cohorts (MRA vs SRA), and analysis was limited to patients with at least 1-year follow-up.
Of 584 LLDKTs, 510 had at least 1-year follow-up (median: 36 months). A total of 393 grafts had an SRA, whereas 117 (23%) had MRA. When complications were stratified by the Clavien classification system, no differences were noted between groups (P = .5). Furthermore, rates of vascular (P = .2) and urological (P = .9) complications were similar between groups. There was, however, a higher incidence of slow graft function in the MRA group (P = .01), despite similar rates of delayed graft function (P = .9) and acute rejection (P = .4). Furthermore, allograft survival was similar between both groups with 76% of MRA and 81% of SRA grafts functioning at 5 years (P = .49). Patient overall survival was likewise similar between groups with 88% of MRA and 86% of SRA recipients surviving at 5 years (P = .76).
Despite a higher incidence slow graft function, MRA in LLDKT does not adversely affect long-term allograft and patient overall survival.
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ABSTRACT: To assess short term morbidity and renal function after robotic laparoscopic living donor nephrectomy. We performed a retrospective analysis of 100 consecutives patients undergoing a robotic laparoscopic living donors nephrectomy. We analyzed isotopic measure of the renal function before and 4 months after surgery, the side, the number of arteries, the blood loss, the operative time and warm ischemia time. In the outcomes, we collected the complications, the length of stay, and for the receiver, the renal function recovery time, dialysis, survival and renal function at one year. Left kidney nephrectomy was performed in 85 patients and we observed 25 multiples renal arteries. Mean estimated blood loss was 0,8g/dL. Mean operative time and warm ischemia time were respectively 174±30 and 4.8±1.7minutes. Seven complications occured, with 2 major (Clavien-Dindo System). Mean length of stay was 5.1±1.9days. Mean glomerular filtration decrease was 26% and remains stable at one year after surgery. Grafts had an immediate renal function recovery for 99%, and were all functional after one year, with mean MDRD clearance of 57±14mL/min. Robotic procedure in laparoscopic living donor nephrectomy seems to guarantee low morbidity and the stability of the renal function decrease of 26%.Progrès en Urologie 04/2014; 24(5):288-93. · 0.80 Impact Factor
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ABSTRACT: In the literature several reconstructive techniques for vascular anastomoses in case of kidney graft vascular variants are reported. This article reports our experience in kidney transplants with vascular anomalies. Between January 1996 and June 2012, 154 cadaveric kidney transplantations were performed at our center. In 35 case, vascular variants were found. Among the arterial variants we observed 27 double arteries, 2 cases with 3 arteries, and 1 case with 4 arteries. All cases of Venous variants were double veins. Based on the type of reconstructive technique used, we divided transplants into group A (n = 22) separate multiple arterial anastomoses; group B (n = 8) anastomosis on the aortic patch; group C (n = 4) single anastomosis in case of 2 arteries with a common ostium at the aortic origin. The venous variants were treated with ligation of the vein of smaller caliber. Kidney preparation to the back table lasted on average 50 minutes with no significant differences between the 3 groups and no significant timing increase compared to renal transplants without vascular anomalies (mean warm ischemia 40 minutes, range 30-60 minutes). The mean cold ischemia time was limited to 16 hours from the removal and the mean warm ischemia was 50 minutes (range 30-70 minutes). There were no differences in timing between group C and single anastomoses, whereas groups A and B showed mean warm ischemia time was slightly increased compared to group C (P < .05). There were no significant differences in terms of delayed upturn of graft function and graft survival between groups A, B, and C and compared to transplants without vascular anomalies. In our series we observed similar results performing the reimplantation on aortic patch and separate multiple arterial anastomoses. Considering our experience, we believe that vascular variants are not an indication to exclude a graft for transplantation.Transplantation Proceedings 09/2013; 45(7):2663-5. · 0.95 Impact Factor
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ABSTRACT: As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, trying to seek and establish the optimal extended criteria. Comprehensive searches were carried out in major databases until November 2013 to search for articles regarding older age, overweight and obesity, hypertension, vascular anomalies/multiplicity, nulliparous women, and minors as donors. Of the 2079 articles found, 152 fell within the scope of the review. Five major guidelines were included and reviewed. Based on the literature search, live kidney donation in older donors (up to 70 years of age) seems to be safe as outcome is comparable to younger donors. Obese donors have comparable outcome to lean donors, in short- and mid-term follow-up. Since little literature is available proving the safety of donation of hypertensive donors, caution is advised. Vascular multiplicity poses no direct danger to the donor and women of childbearing age can be safely included as donors. Although outcome after donation in minors is shown to be comparable to adult donors, they should only be considered if no other options exist. We conclude that the analyzed factors above should not be considered as absolute contraindications for donation.Kidney International 04/2014; · 8.52 Impact Factor