Outcome of Kidney Grafts with Multiple Arteries, Vascular and Urologic Complications

OBJECTIVES: Renal transplantation with multiple arteries is technically demanding and carries higher risk of vascular and urological complications. The aim of this study is to review graft outcomes and surgical complications of kidney transplantation with multiple renal arteries retrospectively. MATERIAL and METHODS: The charts of 39 patients who received kidneys with multiple renal arteries were retrospectively reviewed. The graft function, surgical technique and surgical complications were recorded. RESULTS: Of the 39 grafts, 34 had 2 arteries, 4 had 3 arteries, and 1 had 4 arteries. Various types of surgical techniques, mainly in situ separated 2 anastomoses in 16 patients (41,0%) and ex vivo pantaloon (side-to-side) anastomosis to create a common channel in 24 cases, were performed. Postoperative vascular complications developed in 3 patients. One graft nephrectomy was done on postoperative day 1 due to renal vein thrombosis. Renal artery stenosis occurred in one patient and bleeding from arterial anastomosis was repaired in another patient. Only one urological complication was observed. Urinary leakage from the ureterovesical junction was repaired surgically. Two graft failures occurred due to acute rejection episodes that developed on the postoperative 2nd and 4th month. Patient survival rate was 100%, while graft survival rate was 97%, 90%, and 90% at the postoperative 1st, 6th, and 12th month, respectively CONCLUSIONS: Although grafts with multiple renal arteries carry a relatively higher complication risk, they can be transplanted successfully using meticulous surgical technique. The type of anastomosis should be decided peroperatively based on graft kidney and recipient vascular structure.