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Çoklu Arteri Olan Böbreklerle Yapılan Nakillerde Sonuçlar, Vasküler ve Ürolojik Komplikasyonlar

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

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2010
DOI: 
doi: 10.5262/tndt.2010.1002.69

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
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.
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Abstract (Original Language): 
AMAÇ: Çoklu arterli böbreklerin nakli teknik olarak daha zordur. Bu nedenle vasküler ve ürolojik komplikasyon riski fazladır. Bu retrospektif incelemede çoklu renal arterli böbreklerle yapılan nakil sonuçları ve cerrahi komplikasyonların araştırılması amaçlanmıştır. GEREÇ ve YÖNTEMLER: 1991-2009 yılları arasında böbrek nakli yapılmış ve çoklu renal arteri olan 39 hastanın dosyaları retrospektif olarak taranmış, graft fonksiyonları, cerrahi teknik, vasküler ve ürolojik komplikasyonlar kaydedilmiştir. BULGULAR: Toplam 39 olgunun 34’ünde 2, 4’ünde 3, 1’inde 4 renal arter vardı. Renal artere ve alıcının anatomisine bağlı olarak pek çok farklı cerrahi teknik kullanılmıştır. Olguların 16’sında (%41,0) renal arterler in situ ayrı, 12 sinde (%30,8) ex vivo yan-yana pantalon rekonstrüksiyonu yapıldıktan sonra tek renal arter olarak anastomoz edilmiştir. Postoperatif vasküler komplikasyon 3 hastada gözlenmiştir. Bir olguda renal ven trombozuna bağlı nefrektomi yapılmış, 1 olguda renal arter darlığı, 1 olguda ise renal arterden kanama gözlenmiştir. Ürolojik komplikasyon sadece 1 olguda üreter alt uçtan idrar kaçağı olarak gözlenmiş, cerrahi olarak onarılmıştır. İki olguda böbrek 2. ve 4. ayda gelişen rejeksiyon sonucu kaybedilmiştir. Hasta sağkalımı %100 olup, 1, 6, 12 aylık graft sakalımı sırasıyla %97, %90 ve %90 olarak bulunmuştur. SONUÇ: Çoklu renal arterli olgularda cerrahi risk daha yüksek olmasına rağmen dikkatli cerrahi yaklaşım ile başarılı sonuçlar elde edilebilir. Cerrahi tekniğin şekline böbreğin ve alıcının damar yapısına göre karar verilmelidir.
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  • 2
124-129
  • Turkish

REFERENCES

References: 

1. Novick AC, Magnusson M, Braun WE: Multiple-artery renal
transplantation: Emphasis on extracorporeal methods of donor
arterial reconstruction. J Urol 1979; 122:731-735
2. Roza AM, Perloff LJ, Naji A, Grossman RA, Barker CF: Livingrelated
donors with bilateral multiple renal arteries. A twenty-year
experience. Transplantation 1989; 47:397-399
3. Oesterwitz H, Strobelt V, Scholz D, Mebel M: Extracorporeal
microsurgical repair of injured multiple donor kidney arteries prior
to cadaveric allotransplantation. Eur Urol 1985; 11:100-105
4. Aydin C, Berber I, Altaca G, Yigit B, Titiz I: The outcome of kidney
transplants with multiple renal arteries. BMC Surg 2004; 4:4
5. Bakirtas H, Guvence N, Eroglu M, Ure M, Ozok HU, Karabulut
I, Gul O, Banli O: Surgical approach to cases with multiple renal
arteries in renal transplantation. Urol Int 2006; 76:169-172
6. Basaran O, Moray G, Emiroglu R, Alevli F, Haberal M: Graft and
patient outcomes among recipients of renal grafts with multiple
arteries. Transplant Proc 2004; 36:102-104
7. Benedetti E, Troppmann C, Gillingham K, Sutherland DE, Payne
WD, Dunn DL, Matas AJ, Najarian JS, Grussner RW: Short- and
long-term outcomes of kidney transplants with multiple renal
arteries. Ann Surg 1995; 221:406-414
8. Ali-El-Dein B, Osman Y, Shokeir AA, Shehab El-Dein AB,
Sheashaa H, Ghoneim MA: Multiple arteries in live donor renal
transplantation: Surgical aspects and outcomes. J Urol 2003;
169:2013-2017
9. Makiyama K, Tanabe K, Ishida H, Tokumoto T, Shimmura H,
Omoto K, Toma H: Successful renovascular reconstruction for
renal allografts with multiple renal arteries. Transplantation 2003;
75:828-832
10. Kadotani Y, Okamoto M, Akioka K, Ushigome H, Ogino S,
Nobori S, Higuchi A, Wakabayashi Y, Kaihara S, Yoshimura N:
Management and outcome of living kidney grafts with multiple
arteries. Surg Today 2005; 35:459-466
11. Kumar A, Gupta RS, Srivastava A, Bansal P: Sequential anastomosis
of accessory renal artery to inferior epigastric artery in the
management of multiple arteries in live related renal transplantation:
A critical appraisal. Clin Transplant 2001; 15:131-135
12. Han D, Choi S, Kim S: Microsurgical reconstruction of multiple
arteries in renal transplantation. Transplant Proc 1998; 30:3004-3005
13. El-Sherbiny M, Abou-Elela A, Morsy A, Salah M, Foda A: The
use of the inferior epigastric artery for accessory lower polar artery
revascularization in live donor renal transplantation. Int Urol
Nephrol 2008; 40:283-287
14. Osman Y, Shokeir A, Ali-el-Dein B, Tantawy M, Wafa EW, el-
Dein AB, Ghoneim MA: Vascular complications after live donor
renal transplantation: Study of risk factors and effects on graft and
patient survival. J Urol 2003; 169:859-862
Cilt/Vol: 19, No: 2, 2010, Sayfa/Page: 124-129
129
Aki FT ve ark: Çoklu Arteri Olan Böbreklerle Yapilan Nakillerde Sonuçlar
Türk Nefroloji Diyaliz ve Transplantasyon Dergisi
Turkish Nephrology, Dialysis and Transplantation Journal
15. Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman
HS, Kavoussi LR: Laparoscopic live donor nephrectomy.
Transplantation 1995; 60:1047-1049
16. Desai MR, Ganpule AP, Gupta R, Thimmegowda M: Outcome
of renal transplantation with multiple versus single renal arteries
after laparoscopic live donor nephrectomy: A comparative study.
Urology 2007; 69:824-827
17. Gurkan A, Kacar S, Basak K, Varilsuha C, Karaca C: Do multiple
renal arteries restrict laparoscopic donor nephrectomy? Transplant
Proc 2004; 36:105-107

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