Purpose: Living donor kidneys with two arteries can be revascularized using various techniques depending on anatomy and surgeon preference. We hypothesized that the revascularization technique could impact on the long-term outcomes.

Materials and Methods: We analyzed 1749 living donor renal transplantations performed at our institution between 1999 and 2015. First, we divided the cases into 4 groups: 1 artery (n=1405), 2 arteries with revascularization (n=233), 2 arteries with ligation (n=81) and ≥3 arteries (n=30), and compared the overall outcomes. Second, we subdivided the kidneys with 2 arteries and revascularization (n=230, 3 vascular graft cases were excluded) into 4 groups: end-to-side (ES, n=18), inferior epigastric artery (IEA, n=21), side-to-side (SS, n=126) and direct anastomosis (DA, n=65), and compared outcomes. Kaplan-Meier and log-rank tests were used for analysis.

Results: Ten-year graft and patient survival (GPS) rates were similar for the 4 main groups (p=0.79). In the subgroup analysis, 1y/5y GPS were similar among the 4 groups (1y p=0.63; 5y p=0.38), while SS and DA groups each had 2 immediate graft losses due to thrombosis but ES and IEA had none. However, ES showed the worst 10y GPS (ES: 38.2%, IEA: 85.9%, SS: 82.2% and DA: 87.1%, p=0.038, figure 1). Notably, 50% of graft loss in ES was due to non-rejection (e.g. secondary focal segmental glomerulosclerosis).

Conclusion: The ES technique had equivalent short-/medium-term GPS but markedly shortened 10y GPS. Thus, we conclude that alternative techniques to ES be used for accessory arteries that require revascularization.

CITATION INFORMATION: Yamanaga S, Posselt A, Freise C, Niemann C, Rosario A, Fernandez D, Kobayashi T, Ahearn A, Tavakol M, Kang S.-M. Inferior 10-Year Graft and Patient Survival After End-to-Side Reconstruction for Two Renal Arteries in Living Donor Renal Transplantation. Am J Transplant. 2017;17 (suppl 3).

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