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

Methods: We retrospectively analyzed 1714 living donor renal transplants at our institution between 1999 and 2015. Three hundred and eleven kidneys had dual arteries, and these were categorized into 5 groups; end-to-side (n=18), inferior epigastric artery (n=21), direct anastomosis (n=65), side-to-side (n=126) and ligated (n=81). We then compared the outcomes with that of a control group (single artery, n=1403) using Kaplan-Meier and Cox regression analyses. Cox regression was adjusted by age, sex and race/ethnicity of donor and recipient, side of kidney, transplant period and recipient surgeon.

Results: Compared to the control group, the end-to-side group had increased all-cause graft loss (10 years: 77.2% vs 24.5%, adjusted hazard ratio [aHR] 3.02, 95% confidence interval [CI] 1.30-7.03, p=0.010) and death-censored graft loss (10 years: 82.0% vs 55.9%, aHR 4.17, 95% CI 1.63-10.68, p=0.003), whereas the other groups did not.

Conclusions: Our study shows that 10-year overall survival and death-censored graft survival were significantly worse for end-to-side arterial reconstruction than for other techniques. Alternative techniques to the end-to-side method should be used for accessory arteries that require revascularization.

CITATION INFORMATION: Yamanaga S., Stock P., Tavkol M., Kang S-.M. Do Reconstruction Techniques for Two Renal Arteries Affect Long-Term Graft Survival after Living Donor Renal Transplantation? Am J Transplant. 2017;17 (suppl 3).

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