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Recent Increase in Modern Era of Laparoscopic Donor Nephrectomy

Reza Saidi, MD; Tatsuo Kawai, MD; Peter Kennealey, MD; Georgios Tsouflas, MD; Nahel Elias, MD; Martin Hertl, MD; A. B. Cosimi, MD; Dicken S. C. Ko, MD

Arch Surg. 2009;144(5):472-475.

Objective  To compare the outcome of living donor kidney transplantation using allografts with a single artery with that observed in recipients of allografts with multiple arteries.

Design  Retrospective analysis.

Setting  Tertiary center.

Patients  Three hundred fifty patients who underwent living donor kidney transplantation from January 2000 to March 2007.

Interventions  Living donor kidney transplantation.

Main Outcome Measures  Surgical complications and allograft survival.

Results  Three hundred nineteen allografts (91.1%) had a single artery (group 1) and 31 (8.9%) had multiple arteries (group 2), including 2 arteries in 21 grafts (67.8%), 3 arteries in 6 (19.3%), and 4 arteries in 4 grafts (12.9%). The operative time was shorter in group 1 compared with group 2 (mean [SD], 173 [35] vs 259 [48] minutes; P < .001). The overall surgical complication rate in groups 1 and 2 was comparable (9.6% vs 9.7%; vascular, 2.8% vs 3.2%; urological, 1.6% vs 3.2%; symptomatic lymphocele, 2.8% vs 3.2%; and wound infections, 2.8% vs 3.2%). The actuarial 1- and 5-year allograft survival rates were comparable in both groups (98.4% and 91.5% in group 1 and 96.8% and 87.1% in group 2). A significant increased use of allografts with multiple arteries has been observed in recent years: 7.8% (n = 10) in grafts that were procured by open technique (n = 127), 4.1% (n = 5) during our initial experience with laparoscopic nephrectomy (n = 123), and 16% (n = 16) in the most recent 100 cases (P < .01).

Conclusions  Living donor kidney transplantation in the presence of multiple renal arteries is feasible and safe. Additionally, graft survival and graft function are not adversely affected by the presence of multiple renal arteries in grafts procured laparoscopically. Recently, there has been an increased use of kidneys with multiple arteries with excellent results.

Author Affiliations: Department of Surgery–Transplantation Unit, Massachusetts General Hospital, Boston.

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