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| Year : 2013 | Volume
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| Issue : 3 | Page : 578-579 |
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| Favorable outcome of living donor kidney transplantation following use of grafts with multiple renal arteries |
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Behzad Einollahi, Mohammad Hossein Nourbala, Mohammad Reza Fatahi
Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, I.R. Iran
Click here for correspondence address and email
| Date of Web Publication | 24-Apr-2013 |
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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 2021 Apr 21];24:578-9. Available from: https://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 | |  |
| 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. 
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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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 8. | Guerra EE, Didoné EC, Zanotelli ML, et al. Renal transplants with multiple arteries. Transplant Proc 1992;24:1868.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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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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