Living Donor Kidney Transplantation Using Laparoscopically Procured Multiple Renal Artery Kidneys and Right Kidneys - 20/06/13

Doi : 10.1016/j.jamcollsurg.2013.04.010

Marcio F. Chedid, MD ^a, Carl Muthu, MB, ChB ^a, Scott L. Nyberg, MD, PhD, FACS ^a, Timothy G. Lesnick, MSc ^b, Walter K. Kremers, PhD ^b, Mikel Prieto, MD, FACS ^a, Julie K. Heimbach, MD, FACS ^a, George K. Chow, MD ^c, Mark D. Stegall, MD, FACS ^a, Patrick G. Dean, MD, FACS ^a,^⁎
^a Division of Transplantation Surgery, Department of Surgery and William von Liebig Transplant Center, Mayo Clinic, Rochester, MN
^b Division of Biostatistics, Mayo Clinic, Rochester, MN
^c Department of Urology, Mayo Clinic, Rochester, MN

^∗Correspondence address: Patrick G Dean, MD, FACS, Division of Transplantation Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Abstract

Background

The use of kidneys with multiple renal arteries (MRA) and right kidneys procured laparoscopically for living donor kidney transplantation (LDKT) remains controversial. We aimed to evaluate the short- and long-term outcomes of recipients of LDKT using laparoscopically procured MRA and right kidneys.

Study Design

We reviewed the medical records of all LDKT recipients with laparoscopically procured kidneys from 2000 to 2009. Pediatric recipients and recipients of positive crossmatch and/or ABO-incompatible transplants were excluded. We compared the outcomes of recipients of MRA kidneys with those receiving single renal artery (SRA) kidneys and the outcomes of recipients of right kidneys with those of left kidneys. Renal function was measured by iothalamate clearance and estimated by the abbreviated Modification of Diet in Renal Disease equation.

Results

Multiple renal artery kidneys (192 2-artery and 18 3-artery kidneys) were used in 210 (18.5%) of 1,134 transplantations. The most common reconstructive technique used for MRA kidneys was a side-to-side anastomosis (64.3%). There were no significant differences in vascular complications (1.1% vs 2.4%, p = 0.17), urologic complications (3.1% vs 2.9%, p = 0.47), graft survival at 1 year (94.6% vs 96.1%, p = 0.37), and 1-year iothalamate clearance (64 mL/min/1.73 m² vs 66 mL/min/1.73 m², p = 0.52) between recipients of SRA and MRA kidneys. Five-year graft survival was similar for recipients of SRA and MRA kidneys (83.6% vs 82.6%, p = 0.82) and for recipients of left vs right kidneys (83.7% vs 82.6%, p = 0.70).

Conclusions

Excellent long-term outcomes can be obtained after LDKT using laparoscopically procured MRA and right-sided donor kidneys. Unavailability of an SRA left kidney should not preclude LDKT.

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Abbreviations and Acronyms : eGFR, IQR, LDKT, MDRD, MRA, SRA