Date: Monday, May 4, 2015
Session Name: Poster Session C: Surgical Issues/Ureteral Complications
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Introduction: Multiple renal arteries are found in 18 to 43% of donor kidneys. We've been using cutoff diameter of <2mm for accessory arteries measured by pre-operative CT angiography to determine whether to sacrifice or reconstruct the artery unless the branches feed the ureter. We aimed to assess the validity and feasibility of this cutoff value.
Patients&Methods: Living related kidney recipients between 2005 and 2013 were enrolled in this retrospective study. Deceased donor cases and recipients younger than 15 y.o. at transplant were excluded. Diameter of accessory artery, reconstructive techniques, and adverse events were evaluated. Moreover, lost parenchymal volume (%) due to obstruction or ligation of accessory artery was calculated by CT volumetry using ziostation2 software (Ziosoft, Inc.).
Results: In 128 kidney transplants, 30 donor kidneys had multiple arteries: 2 arteries in 27 cases and 3 in 3. Accessory arteries were reconstructed in 18 cases and intentionally ligated in the other 12 cases. Mean diameter of accessory arteries were 3.10±0.75mm and 1.81±0.28mm, respectively (p<0.05). Reconstructive techniques were hypogastric artery graft (10 cases), conjoined (4 cases), end-to-side anastomosis to main trunk (3 cases), and combination of end-to-side and conjoined (1 case). Mean eGFR at 1 month and 1 year after transplant were not significantly different. In reconstructed cases, 14 cases (77.8%) had good patency in the reconstructed arteries whereas the other 4 had vascular complications (obstruction in 1 and stenosis in 3 cases). When renal parenchymal volume loss due to ligation or occlusion of the accessory artery was calculated (16 cases were evaluated), it was predictable with a formula: lost volume (%) = 9.09 x D (diameter, mm) – 10.5 (p=0.027, rs=0.533 by Spearman's rank Correlation Coefficient). According to the formula, ligation of an accessory artery of 2mm leads to loss of 7.68% of renal parenchyma.
Conclusions: Cutoff value of 2mm is worth trying to reconstruct in terms of successful rate and graft function. Sacrifice of accessory artery with 2mm leads to parenchymal loss smaller than 8%.
To cite this abstract in AMA style:Iwami D, Morita K, Sasaki H, Oishi Y, Higuchi H, Shinohara N. 2mm Is Reasonable and Feasible Cutoff Value of Indication for Vascular Reconstruction in a Kidney Allograft With Multiple Arteries [abstract]. Am J Transplant. 2015; 15 (suppl 3). http://atcmeetingabstracts.com/abstract/2mm-is-reasonable-and-feasible-cutoff-value-of-indication-for-vascular-reconstruction-in-a-kidney-allograft-with-multiple-arteries/. Accessed April 30, 2017.
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