Introduction

Due to organ scarcity living donation is becoming a major source of kidneys for transplantation. Besides medical contraindications, anatomy of the kidneys may be a challenge for the surgeon. Multiple arteries, multiple veins, short right renal vein and ureter duplex may be considered as a contraindication for living donation. We herein describe all consecutive cases of living donor kidney transplantations carried out at our institution since October 2014 with a focus on technical challenges and the algorithm of acceptance and side preference.

Methods

Retrospective analysis of all living donor kidney transplantations from October 2014 – October 2017. Donor imaging has been carried out by multislice computed tomography with 3D reconstruction. Side selection has been based on an algorithm including 3MAG scintigraphy and anatomy. Endpoints were donor exclusion for anatomical reasons and vascular complications in the recipients.

Results

100 living donor kidney transplants have been carried out during the time period. No single donor (0%) has been excluded for anatomical reasons. Side preference was mainly based on lower 3MAG creatinine clearance (86%) while in 14% the slightly better kidney was chosen due to anatomical reasons (multiple arteries n=10, short renal vein n=2, multiple renal veins n=2). 23 vessels had to be reconstructed backtable (multiple arteries n=15, early branching n=7, multiple veins n=1) and in 2 cases a pole artery was anastomosed to the epigastric inferior artery. Ureter duplex was found unexpectedly in one case intraoperatively. One recipient (1%) underwent surgical revision due to kinking of the renal artery with favorable outcome. No kidney was lost due to surgical reasons.

Conclusions

Anatomical variations should not be a contraindication for living donor kidney transplantation. Microsurgical reconstruction and optimal choice of the side are crucial for favorable outcomes.

CITATION INFORMATION: Öllinger R., Alqasim K., Klein F., Raschzok N., Ritschl P., Chopra S., Otto N., Denecke T., Gerlach U., Schmelzle M., Reinke P., Pratschke J. Technical Challenges in Living Donor Kidney Transplantation – Diagnosis and Solutions Am J Transplant. 2017;17 (suppl 3).

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