Vascular allografts are used routinely in pancreas, intestine and occasionally in liver transplantation. We propose that selective use of vascular allografts may increase utilization of injured kidneys or kidneys with advanced atherosclerosis that would otherwise be discarded.

Patients and methods: Stored vascular allografts, of the same or compatible blood type were used in all cases within 14 days of recovery. All serologies were negative and consent was obtained. The vascular grafts were placed on the recipient vessels or on the renal allografts before reperfusion. Indications included injured, short or atherosclerotic renal vessels and problems with the recipient's vessels, including previous endovascular surgery. During the study period, 338 renal transplants were performed at our center. Of them, 29 were recipients of LRD and 309 were recipients of deceased donor kidneys. Results: 8 Patients received arterial and 11 patients received venous allografts. Four patients required both arterial/venous allografts at the same time. Indications for use were short vessels after deceased donor nephrectomy (n=8), short vessels after laparoscopic donor nephrectomy (n=8), severe accidental arterial injury during laparoscopic nephrectomy (n=1), severe atherosclerosis of the proximal renal artery (n=3), severe atherosclerosis of the recipient (n=2), endoprosthesis that limited inflow sites (n=1). Follow up is from date of transplant till November 30, 2017. All kidneys are functioning normally to date. The overall DGF rate was 17%. There have been no vascular complications and all of the kidneys have patent vessels with normal resistive indices on Doppler ultrasound examination. The creatinine range at discharge was between 0.59-9.2 with the median being 2.14. Current patient creatinines range from 0.7-2.14 with the median being 1.22. All patients are alive with functional transplanted renal allografts with the exception of one patient who is still having DGF. Conclusion: Vascular allografts facilitated potentially complex kidney transplants and helped salvage kidneys with abnormal macrovascular disease that were turned down by other transplant centers due to anatomic considerations. Thus, vascular allografts should be available when kidney transplantation is anticipated to be complex and should be included in the armamentarium to help improve organ utilization of usable deceased donor kidneys with vascular complications.

CITATION INFORMATION: Reino D., Schnickel G., Ale E., Ebaid S., Agrawal N., Rhazouani S., Gebreselassie S., Tzakis A. Vascular Allografts in Renal Transplantation Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress