Background

Procurement side of living donor kidney is decided according to the kidney function. We procure the kidney with lower function for the remaining donor kidney function. Without functional discrepancy nor any other reasons, we decided to procure left kidney, even for the cases with multiple vessels. So we sometimes need to reconstruct arteries before transplant.

Objective and Method

In 531 recipients who underwent living donor kidney transplants between January 2008 and April 2014, 113 grafts needed arterial reconstruction before transplant. We investigated the total ischemic time, time to initial urination, graft function and adverse events comparing reconstruction cases with non reconstruction cases.

Results

113 grafts required arterial reconstructions including 79 conjoined reconstructions , 19 interpositions with recipients' internal iliac arteries and 15 end to side reconstructions. 418 grafts were transplanted without reconstruction.

Total ischemic time was significantly longer in reconstruction cases than in Non reconstruction cases. There was no significant difference in time to initial urination. Graft functions evaluated with eGFR were significantly better only in postoperative day 1 and 2 in non reconstruction cases . There was no significant difference in eGFR in the Conjoined cases, Interposition cases and End to side cases compared with Non reconstruction cases. Postoperative adverse events like ureteric stenosis, urine leakage and reoperation for arterial obstruction were identified without significant difference.

Conclusion

We could obtain the same graft functions even in the reconstruction cases with the least postopearative adverse events as in the non reconstruction cases. And the graft functions did not differ in the reconstruction technique.

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