Deceased donor (DD) kidneys exhibiting severe atherosclerosis with hard ulcerative occlusive plaque extending into the renal artery (RA) may represent a contraindication to utilization. Limited data are available on eversion endarterectomy (EE) as a salvage procedure to permit kidney transplantation (KT). Methods: EE was performed by subintimal dissection of the Carrel aortic patch followed by complete eversion and removal of the RA cast. Patients (pts) received localized heparin intra-operatively and aspirin post-operatively. All pts received depleting antibody induction with tacrolimus/mycophenolate maintenance therapy. Results: We identified 11 cases (1% of all DD KTs during the study period) involving EE of the DD RA. 9 (82%) of the kidneys were imported; 8 (73%) were from ECDs and mean KDPI was 83%. Kidneys were accepted on anatomic waivers and all resulted in successful KT. Mean DD age was 62 yrs, creatinine clearance 75 ml/min, and cold ischemia time 27 hrs. All kidneys were placed on machine preservation; mean pump time was 9 hrs (mean flow 112 and resistance 0.28). Mean plaque length was 1.7 cm and mean glomerulosclerosis on biopsy was 10%. Mean recipient age was 61 yrs and mean dialysis vintage was 38 months. With a mean follow-up of 29 months, actual pt and graft survival rates are both 64%. One pt died early without evidence of a technical problem. Of the remaining 10 pts, 2-year pt and graft survival rates were both 100%. There were no early or late vascular complications. The incidence of delayed graft function was 27% and mean length of initial hospital stay was 4.6 days. Mean serum creatinine and GFR levels in pts with functioning grafts at latest follow-up were 1.8 mg/dl and 40 ml/min, respectively. Conclusions: EE appears to be a safe and under-utilized procedure that may prevent discard of marginal donor kidneys and is associated with acceptable short-term outcomes.

CITATION INFORMATION: Khan M, Jones K, El-Hennawy H, Farney A, Rogers J, Orlando G, Stratta R. Eversion Endarterectomy of the Deceased Donor Renal Artery to Prevent Kidney Discard. Am J Transplant. 2016;16 (suppl 3).

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