EPIDEMIOLOGY AND CLINICAL OUTCOMES

I.S. Moon¹, J.K. Hwang², J.I. Kim¹, S.C. Park³, C.W. Yang⁴, S.N. Kim⁵, Y. Koh^6
1Department Of General Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea, Seoul/KOREA, ²Division Of Transplant Surgery, Seoul St. Mary's Hospital, Seoul/KOREA, ³Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea, Seoul/KOREA, ⁴Division Of Nephrology, Department Of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea, Seoul/KOREA, ⁵Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea, seoul/KOREA, ⁶Surgery, Catholic Univ. Medical Center, Seoul/KOREA

Body: The long-term outcomes of Kidney transplants with multiple renal arteries. IS Moon, JK Hwang, JI Kim, SC Park, CW Yang², SN Kim, YB Koh. Division of Transplant Surgery, Department of Surgery, Department of Internal medicine², Seoul St. Mary’s Hospital, The Catholic University of Korea Introduction The kidneys with multiple renal artery (MRA) are increasingly procured for transplant. To suggest the outcomes of kidney transplantation using allografts with multiple arteries, we compare the long term graft function and survival of kidneys with single artery and multiple renal artery according to their arterial anastomosis over a 19-year period. Methods We analyzed 1186 kidney transplants done from July 1, 1990 through December 31, 2008 in which only the recipients external iliac artery (EIA) or internal iliac artery (IIA) was used for anastomosis. We divided the study recipients into 4 groups. Group I: single renal artery, single arterial anastomosis (n=891, 75.1%) (Ia (n=771); end to end anastomosis to IIA, Ib (n=120); end to side anastomosis to EIA), Group II : multiple renal artery, single anastomosis(n=24, 2.0%) (IIa (n=23); anastomosis to IIA, IIb(n=1); anastomosed to EIA), Group III : multiple renal artery, multiple anastomosis (n=237, 20.0%) (IIIa(n=201); main renal artery anastomosed to IIA, IIIb (n=36); main renal artery to EIA), Group IV : polar artery ligation (n=34, 2.9%) (IVa (n=31): upper polar artery ligation, IVb (n=3): lower polar artery ligation). We compared the following variable: patient and graft survival, mean creatinine levels at 1, 6 month, 1, 3, and 5 years post-transplant and number of rejection episode. Results Among those groups, there is a significant difference in total ischemic time. (p=0.011, group I, IV vs group II) We compared mean creatinine levels and incidence of acute rejection episodes among the four groups as a measure of graft function. The creatinine value at 1month , I year, 3 years and 5 years post-transplnat did not differ significantly (p=0.399). The incidence of acute rejection episode was 34.5% in Group I, 33.3% in Group II, 33.8% in group III, and 32.4% in Group IV. The difference was not significant (p=0.990) Graft survival rates at 1, 5, 10 and 15 years post-transplant were 88.6%, 79.4%, 67.8% and 53.6% in Group I, 90.5%, 84.4%, 76% in Group II( median survival time is 156 month), 90.5%, 79.5%, 71.1% and 50.3% in Group III, 84.5%, 80.9%, 68.9% and 42.5% in Group IV. There are no significant differences among the four groups in graft survival (p=0.951) and patient survival (p=0.751). But, we subdivided the four groups according to the anastomosed artery and compared the graft survival rate each others. The group IIIb showed better graft survival than group IIIa (p=0.037) Conclusion Multiplicity of renal arteries in kidney transplantation does not adversely affect allograft survival and patient survival compared with the single renal artery group. And when the donor kidney have multiple renal arteries, our data suggested that main renal artery anastomosed to EIA would be better.

Disclosure: All authors have declared no conflicts of interest.