V02-11: Living donors with multiple renal arteries are not a contraindication for Robotic Kidney transplantation: Techniques for success and their outcomes
Kidney Transplant with multiple renal arteries is technically challenging. A higher incidence of vascular and urological complications have been reported in some studies. Hence, there is hesitation in using grafts with multiple arteries. In current practice, excluding otherwise suitable live donors only on basis of technical challenges no longer seem acceptable. This becomes particularly important in settings where cadaveric donor program is still in its infancy and where living donor nephrectomy contributes to majority of graft pool.We present a video highlighting our technique and experience in Robotic kidney transplants using grafts with multiple vessels.
Of a total of 964 patients who underwent renal transplantation, 202 were operated upon robotically from February 2013 to June 2017. Multiple renal arteries were assessed preoperatively by studying CT renal angiographic 3D reconstruction images and also on the bench after graft retrieval. Depending on the location and size of graft vessels, decision was taken to make pantaloon anastomosis, anastomose vessel separately to ipsilateral inferior epigastric artery or external iliac or sacrifice it if insignificant.
Patients were divided into two groups based upon number of renal arteries in the graft. Out of 202 grafts, 157 grafts (77.7%) had a single renal artery (SRA) and remaining 45(22.3%) had multiple renal arteries (MRA). 36 allografts had 2 renal arteries while 6 grafts had a single renal artery, which got divided into two during retrieval. Three grafts had 3 renal arteries. The mean age for MRA group was 37.5 and for SRA group was 39.08. Mean BMI was 25.95 and 24.7 in MRA & SRA group respectively. The mean warm ischemia time (WIT) in MRA group was 166 seconds, which was significantly higher than that in SRA group (147.8 seconds), p value 0.005. The mean total ischemia time in patients receiving graft with multiple renal arteries was significantly higher as compared to the patients receiving grafts with single renal artery (79.8 minutes in MRA vs. 65.2 min in SRA, p value 0.0001). Blood loss was found to be similar in the two groups. The mean creatinine levels at discharge (1.17 mg/dl in MRA group and 1.27 mg/dl in SRA group) and at 3 months (1.18 mg/dl in MRA group and 1.26 mg/dl in SRA group) were comparable.
Multiple renal arteries, albeit technically challenging, are not a contraindication for robotic kidney transplant. The outcomes are comparable with grafts having single renal artery.