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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 3  |  Page : 578-579
Favorable outcome of living donor kidney transplantation following use of grafts with multiple renal arteries


Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, I.R. Iran

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Date of Web Publication24-Apr-2013
 

How to cite this article:
Einollahi B, Nourbala MH, Fatahi MR. Favorable outcome of living donor kidney transplantation following use of grafts with multiple renal arteries. Saudi J Kidney Dis Transpl 2013;24:578-9

How to cite this URL:
Einollahi B, Nourbala MH, Fatahi MR. Favorable outcome of living donor kidney transplantation following use of grafts with multiple renal arteries. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Dec 8];24:578-9. Available from: http://www.sjkdt.org/text.asp?2013/24/3/578/111071
To the Editor,

We read with great interest the article by Kamali et al [1] entitled "Renal transplantation in allografts with multiple versus single renal arteries," published in your valuable journal. This retrospective study focused its message on whether grafts with multiple renal arteries (MRAs) have impact on the outcome of living donor kidney transplantation. Delayed graft function (DGF) was more frequently seen in patients with grafts having MRAs compared to those who received grafts with single renal artery (SRA), [1] which was consistent with other reports. [2],[3] Although it is reasonable that pre­sence of MRAs may lead to increase in ope­ration time which may contribute to the deve­lopment of DGF, we found no significant dif­ference in the warm ischemia time between recipients with MRAs and patients with SRA. [4] Overall, warm and cold ischemia times in our previous report were shorter than those repor­ted in other studies. [2],[5],[6]

It is of interest that Kamali et al [1] did not find a higher rate of acute rejection in recipients with MRAs when compared to patients re­ceiving allografts with SRA, which was con­sistent with the report of Benedetti and co-workers. [7] However, the incidence of acute re­jection episodes was significantly higher in the MRAs' group than the SRA group among our patients. [4]

In addition, renal artery stenosis (RAS) was more likely to occur in patients receiving kidneys with MRAs than SRA, [1] which was simi­lar to that reported earlier. [8],[9] However, Kamali et al [1] found no significant differences in the occurrence of postoperative complications such as renal artery thrombosis and hematoma in the two groups, as has been reported by pre­vious studies; [4],[7] it can be attributed to the fact that multiple arteries were converted to a single artery by bench reconstruction. [7] In con­trast, a number of investigations carried out previously have suggested that grafts with MRAs are associated with a higher risk for vascular complications, especially hemorrhagic complications and arterial thrombosis. [3],[8],[10],[11],[12]

We agree that patients receiving kidneys with MRAs have a favorable short-term patient and graft outcome. [1],[7],[8],[13] Although we showed that using grafts with two arteries is safe and yiel­ded the same 1-year patient and graft survival as those with SRA, grafts with three arteries had unfavorable outcome, [4] which was consis­tent with other reports. [5],[6],[8]

Some authors have previously reported that kidneys with MRAs are a relative contra­indication for transplantation because of the increased incidence of vascular and urologic complications. [10],[12] However, other studies have indicated that living donor kidney trans­plantation using grafts with MRAs is safe and results in acceptable patient and allograft outcome. [1],[4],[5],[6],[8]

 
   References Top

1.Kamali K, Abbasi MA, Ani A, Zargar MA, Shahrokh H. Renal transplantation in allografts with multiple versus single renal arteries. Saudi J Kidney Dis Transpl 2012;23:246-50.  Back to cited text no. 1
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2.Kadotani Y, Okamoto M, Akioka K, et al. Management and outcome of living kidney grafts with multiple arteries. Surg Today 2005; 35:459-66.  Back to cited text no. 2
    
3.Ghazanfar A, Tavakoli A, Zaki MR, et al. The outcomes of living donor renal transplants with multiple renal arteries: A large cohort study with a mean follow-up period of 10 years. Transplant Proc 2010;42:1654-8.  Back to cited text no. 3
    
4.Abbaszadeh S, Nourbala MH, Alghasi M, Sharafi M, Einollahi B. Does renal artery multiplicity have impact on patient and allograft survival rates? Nephrol-Urol Mon 2009; 1:45-50.  Back to cited text no. 4
    
5.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;36:102-4.  Back to cited text no. 5
    
6.Troppmann C, Wiesmann K, McVicar JP, Wolfe BM, Perez RV. Increased transplantation of kidneys with multiple renal arteries in the laparoscopic live donor nephrectomy era: Surgical technique and surgical and non-surgical donor and recipient outcomes. Arch Surg 2001;136:897-907.  Back to cited text no. 6
    
7.Benedetti E, Troppmann C, Gillingham K, et al. Short- and long-term outcomes of kidney transplants with multiple renal arteries. Ann Surg 1995;221:406-14.  Back to cited text no. 7
    
8.Guerra EE, Didoné EC, Zanotelli ML, et al. Renal transplants with multiple arteries. Trans­plant Proc 1992;24:1868.  Back to cited text no. 8
    
9.Hsu TH, Su LM, Ratner LE, Trock BJ, Kavoussi LR. Impact of renal artery multi­plicity on outcomes of renal donors and reci­pients in laparoscopic donor nephrectomy. Urology 2003;61:323-7.  Back to cited text no. 9
    
10.Roza AM, Perloff LJ, Naji A, Grossman RA, Barker CF. Living-related donors with bilateral multiple renal arteries. A twenty-year experience. Transplantation 1989;47:397-9.  Back to cited text no. 10
    
11.Osman Y, Shokeir A, Ali-el-Dein B, et al. Vascular complications after live donor renal transplantation: Study of risk factors and effects on graft and patient survival. J Urol 2003;169: 859-62.  Back to cited text no. 11
    
12.Khanam A, Alam MR, Ahmed AH, Khan SA. The outcome of kidney transplants with multi­ple renal arteries. Mymensingh Med J 2011;20: 88-92.  Back to cited text no. 12
    
13.Mazzucchi E, Souza AA, Nahas WC, Antonopoulos IM, Piovesan AC, Arap S. Surgical complications after renal transplantation in grafts with multiple arteries. Int Braz J Urol 2005;31:125-30.  Back to cited text no. 13
    

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Correspondence Address:
Behzad Einollahi
Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran
I.R. Iran
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DOI: 10.4103/1319-2442.111071

PMID: 23640636

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