Multiple Arteries Do Not Worsen Transplant Outcomes
VANCOUVER, British Columbia—Transplantation of kidneys with single or multiple arteries results in similar long-term outcomes, according to new study presented at The Transplantation Society's 2010 congress.
A team from the Catholic University of Korea in Seoul presented results from 1,186 living- and deceased-donor transplants they performed between July 1990 and December 2008. The researchers, led by Ji Il Kim, MD, divided transplants into four groups. Group I included 890 transplants with a single artery and single anastomosis. Group II included 26 transplants that had multiple arteries attached with a single anastomosis. Group III included 236 transplants that had multiple arteries attached with multiple anastomoses. Group IV include transplants involving polar artery ligation.
The 15-year graft survival rates were 55.92%, 51.56%, 49.04%, and 53.94% for groups I, II, III, and IV, respectively. The 15-year patient survival rates were 83.56%, 81.16%, 76.93%, and 75.12%, respective. None of the group differences were statistically significantly.
The average total ischemic time, however, was significantly lower in group I than in group II and IV (69.3 vs. 129 and 88.8 minutes, respectively). Among the living donor cases alone, the average total ischemic time was also significantly shorter in group I than in groups II and III: 38.8 vs. 53.7 and 48.6 minutes.
The rates of vascular and urologic complications did not differ significantly between single-artery and multiple-artery donor kidneys. The researchers observed a 1.3% rate of renal artery stenosis in group I, a 0% rate in groups II and IV, and a 0.1% rate in group III. The renal infarction rate was 0.1% in group I, 0% in groups II and IV, and 0.1% in group IV. The rate of urine leakage was 0.8% in group I, 0% in group II, 0.4% in group III and 0.1% in group IV. The lymphocele rate was 1.4%, 0.2%, 0.7%, and 0.1%, respectively.
“The authors should be congratulated on their excellent results with renal transplants with multiple renal arteries,” commented Michael Hanaway, MD, an associate professor in the Division of Transplantation at the University of Alabama in Birmingham. “While it is not readily apparent in the demographics information, it would appear that most of the transplants performed were from live donors. It would be interesting to know how the current patient population would compare to a group of deceased donors where multiple arteries were re-implanted on a single Carrell patch as opposed to each artery being reimplanted individually.”
For many transplant centers performing live donor renal transplants, he added, the most important conclusion “is that donors with multiple renal arteries can be used with excellent short-and long-term success. However, this success is very dependent on technical surgical expertise and experience.”