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19 September 2014 : Original article  

Vascular Challenges in Renal Transplantation

Tolga Atilla SagbanABCDEF, Barbara BaurBC, Hubert SchelzigDE, Klaus GrabitzBDF, Mansur DuranBF

DOI: 10.12659/AOT.890893

Ann Transplant 2014; 19:464-471

Abstract

BACKGROUND: The increasing demand for transplantable organs, especially kidneys, has led to expanded criteria for renal transplant donors. As a result of the expanded criteria, more organs with vascular anomalies and/or pathologies are available for transplant. This retrospective study evaluated the impact of vascular repair on the outcome in kidney transplantation in a single center over a 15-year period.

MATERIAL AND METHODS: Between January 1997 and May 2012, 1134 deceased donor renal transplantations were performed in the Department for Vascular and Endovascular Surgery of the University of Düsseldorf, Germany.

RESULTS: A vascular reconstruction of some type was necessary to repair renal vessels or to prepare the recipient site for transplantation in 374 of 1134 (33.0%) renal transplantations. The iliac artery in 12.3% (139/1134) of cases and the renal artery in 10.1% (115/1134) of cases showed severe atherosclerosis and a thrombo-endarterectomy was required. Organ loss occurred in 13 cases (1.1%) due to vascular failure. The 5-year graft survival for kidneys with reconstructed renal arteries was 84.3% in deceased donor renal transplantations (86.1% without arterial reconstruction).

CONCLUSIONS: The demand for renal transplants has led to more marginal-quality organs and older donors and/or recipients waiting for a second or third transplantation. Thus, the expertise of a vascular surgeon is extremely helpful in a transplantation center because it allows for marginal organ transplantation with acceptable 5-year graft survival rates.

Keywords: Renal Artery, Renal Artery Obstruction, vascular calcification

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358