Background

Lack of suitable sites for arterial anastomoses presents a distinct challenge for renal transplantation in patients with significant peripheral arterial occlusive disease.

Methods

We present a case of a 66 year old female with radiation nephropathy resulting from ovarian dysgerminoma treated with surgical debulking and pelvic irradiation at age of 16. Angiogram revealed occlusion of the left common and external iliac arteries and high grade stenosis of the right common iliac. Balloon angioplasty with stent placement improved inflow on the right. Donor-specific antibodies were present for her living donor option, so she was evaluated for paired-donor exchange. A suitable unrelated living donor was identified with no DSA. The donor graft had two arteries and intraoperatively the recipient right external iliac artery was severely atherosclerotic. In conjunction with Vascular Surgery, an interposition Dacron graft was placed and renal arteries anastomosed to the graft separately.

Results

The patient had excellent immediate graft function. At one and two year follow up she continued to have excellent graft function with a creatinine of 0.9 and 0.7 ng/ml.

Conclusion

Review of the literature supports implantation of renal allograft arteries to prosthetic vascular grafts, but this is the first reported case of paired-donor exchange living donor renal transplantation with two arteries anastomosed to a simultaneously placed vascular prosthetic graft. Severe peripheral arterial occlusive disease in itself should not preclude renal transplantation. Coordinated care with transplant and vascular surgeons may optimize success in these patients.

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