Sage Journals: Discover world-class research

Abstract

Background. The incidence of vascular complications during allogeneic renal transplantations ranges from 5% to 15%. They may be donor related (additional polar arteries, multiple renal arteries, multiple renal veins, injured arteries or veins), recipient related (severe atherosclerosis, venous thrombosis, previous transplantation), or technical. In a retrospective study of 666 kidney transplantations, the incidence and treatment of vascular complications were analyzed.

Patients/Results. All transplantations were performed in end-to-side technique with aortic patch if available; all kidneys were obtained from brain-dead donors. A total of 89 operations included vascular complications (13.4%). In 46 patients (6.9%), the problem arose intraoperatively, 33 complications (5%) occurred within three weeks, and another 10 (0.3%) were seen later after successful transplantation. In 17 kidneys, major additional polar arteries were encountered, 7 of which were reanastomosed, 10 were ligated. Three kidneys were lost owing to insufficient blood supply to the ureter. In 7 patients, intraoperative vascular service operations had to be carried out owing to stenosis of the iliac artery or massive kinking. Early postoperative complications included bleeding after biopsy, anastomotic leakage, and arterial or venous thrombosis (1 successful venous thrombectomy; 18 of 33 organs were removed). As for late complications, the authors observed 9 transplant renal artery stenoses (TRAS); 8 were treated by percutaneous transluminal angioplasty. One patient developed an iliac aneurysm owing to chronic patch rupture.

Conclusion. The majority of intraoperative complications were due to injury of the kidney during donor nephrectomy (21/46). Polar arteries should be reconstructed if possible, especially lower polar arteries, because of the danger of ureteral necrosis. In times of increasing donor organ shortage, only experienced surgeons should perform explantation and transplantation of kidneys to avoid technical faults in a considerable number of organs.

Get full access to this article

View all access options for this article.

References

1. Starzl TE , Marchioro TL , Rifkind D , et al: Factors in successful renal transplantation. Surgery 56:296-318, 1964.

2. Höhnke C , Abendroth D , Schleibner S , et al: Vascular complications in 1200 kidney transplantations. Trans Proc 19:3691-3692, 1987.

3. Tzakis AG , Mazzaferro V , Pan CE , et al: Renal artery reconstruction for harvesting injuries in kidney transplantation with particular reference to the use of vascular allografts. Transplant Int 1:80-85, 1988.

4. Bollinger RR , Vaughn W , Spees E , et al: The impact of donor renal abnormalities in cadaver transplantation. Trans Proc 18:459-462,1986.

5. Michel F , Gattegno B , Scetbon V , et al: Surgical damage to cadaveric kidney graft during procurement. Trans Proc 16:288-289, 1984.

6. Ploeg RJ , van Schilfgaarde R , Felthuis W , et al: Influence of anatomical variations on the incidence of surgical lesions in cadaveric donor kidneys. Trans Proc 16:120-121, 1984.

7. Bouchou F , Kamel G , Gelet A , et al: Transplantation of kidneys with multiple renal arteries. Trans Proc 16:273-275, 1984.

8. Guerra EE , Didone EC , Zanotelli ML , et al: Renal transplants with multiple 'arteries. Trans Proc 24:1868-1868, 1992.

9. Müller GH , Hähn U , Greger B , et al: Effect of anastomosis time and intraoperative organ cooling on primary function in renal transplantation. Trans Proc 21:1239-1239, 1989.

10.

10. Hammoudi BG , Moukarzel M , Bellamy J , et al: Renal transplant reparative ex vivo surgery: Prevention of vascular complications. Clin Transpl 3:190-193, 1989.

11.

11. Chopin DK , Popoy Z , Abbou CC , et al: Use of vena cava to obtain additional length for the right renal vein during transplantation of cadaveric kidneys. J Urol 141:1143-1144, 1989.

12.

12. Stratta RJ , D'Allessandro AM , Belzer FO : Renal vein reconstruction with interposition allografts in cadaveric renal transplantation. Transplant Int 1:86-90, 1988.

13.

13. Rosenthal JT , Loo RK : Portal venous drainage for cadaveric renal transplantation. J Urol 144:969-971, 1990.

14.

14. Chin JL : Microvascular reconstructive “bench” surgery for donor kidneys before transplantation: Techniques and results. J Urol 142:23-27, 1989.

15.

15. Tschervenkov JI , Munda R : The use of the hypogastric artery, in the anastomosis of multiple renal arteries in the transplant recipient. Transplant Int 3:116-117, 1990.

16.

16. Yussim A , Shapira Z , Shmueli D , et al: Vascular problems and their management in retrieval of donor kidneys. Trans Proc 16:290-291, 1984.

17.

17. Roberts JP , Ascher NL , Fryd DS : Transplant renal 174 Storck Complications in Renal Transplantations artery stenosis. Transplantation 48:580-583, 1989.

18.

18. Benoit G , Moukarzel M , Hiesse C , et al: Transplant renal artery stenosis: Experience and comparative results between surgery and angioplasty. Transplant Int 3:137-140, 1990.

19.

19. Sutherland RS , Spees EK , Jones JW , et al: Renal artery stenosis after renal transplantation: The impact of the hypogastric artery anastomosis. J Urol 149:980-985, 1993.

20.

20. Abendroth D , Ingrisch H , Castro LA , et al: Incidence and management of transplant renal artery stenoses. Thorac Cardiovasc Surgeon 31 (Spec. Issue I):27-27, 1983.

21.

21. Thomas CP , Riad H , Johnson BF , et al: Percutaneous transluminal angioplasty in transplant renal arterial stenoses: A long-term follow-up. Transplant Int 5:129-132, 1992.

22.

22. Benoit G , Hiesse C , Icard P , et al: Treatment of renal artery stenosis after renal transplantation. Trans Proc 19:3600-3601, 1987.

23.

23. Spijkerboer AM , Mali WPTM , Donckerwolche RAMG : Renal transplant artery stenosis in children: Treatment with percutaneous transluminal angioplasty. Pediatr Radiol 22:519-521, 1992.

24.

24. Stanley P , Malekzadeh M , Diament MJ : Posttransplant renal artery stenosis: Angiographic study in 32 children. Am J Radiol 148:487-490, 1987.

25.

25. Alliabadi H , McLories A , Churchill BM , et al: Percutaneous transluminal angioplasty for transplant renal artery stenosis in children. J Urol 143:569-573, 1990.

26.

26. Buckley JG , Salimi Z , George E : Late onset renal allograft anastomotic pseudoaneurysm with absent Doppler signal. J Urol 148:392-394, 1992.

27.

27. List A , Collins J , MacCormick M : Massive hemorrhage from an arterioureteral fistula associated with chronic renal transplant failure. J Urol 144:1229-1230, 1990.

28.

28. Skotnicki SH , van Asten WNJC , Beijneveld WJ , et al: Evaluation of renal allograft function by Doppler spectrum analysis. Transplant Int 2:16-22, 1989.

29.

29. Berger H , Habersetzer R , Jauch KW , et al: Katheterembolisation intrarenaler arterio-venoser Fistelbildungen. Chirurg 58:675-677, 1987 (English summary).

Vascular Complications in Allogeneic Renal Transplantations

Abstract

Get full access to this article

References