Laparoscopic procurement of single versus multiple artery kidney allografts: is long-term graft survival affected?

• Published in: Transplantation Vol. 88; no. 10; p. 1203
• Main Authors: Paramesh, Anil, Zhang, Rubin, Florman, Sandy, Yau, C Lillian, McGee, Jennifer, Al-Abbas, Haythem, Amatya, Arun, Killackey, Mary, Slakey, Douglas
• Format: Journal Article
• Language: English
• Published: United States 27.11.2009
• Subjects: Adult; Follow-Up Studies; Graft Rejection - epidemiology; Graft Survival - immunology; Graft Survival - physiology; Humans; Incidence; Kidney Failure, Chronic - etiology; Kidney Transplantation - immunology; Kidney Transplantation - mortality; Kidney Transplantation - physiology; Laparoscopy - methods; Middle Aged; Nephrectomy - methods; Renal Artery - abnormalities; Renal Artery - surgery; Retrospective Studies; Surgical Procedures, Operative - methods; Survival Rate; Survivors; Time Factors; Treatment Failure; Treatment Outcome; Young Adult
• ISSN: 1534-6080
• DOI: 10.1097/TP.0b013e3181ba343a

Living donor kidneys with multiple arteries (MA) are increasingly procured laparoscopically for transplant. We compare long-term graft function and survival of kidneys with single arteries (SA) and MA over a 10-year period. There were a total of 218 grafts with SA and 60 grafts with MA. The MA group had longer operative and ischemic times than SA group. There was a small increase in ureteral complication (8.3% vs. 2.3% P=0.06) and a significantly higher incidence of rejection (23.3% vs. 10.1%, P=0.01) in MA group than in SA group. Graft function was lower in MA group than SA group. The 5-year graft survival by Kaplan Meier analysis was better in SA group than in MA group (P=0.023). The estimated graft survivals at 1, 3, and 5 year were 94.4%, 90.6%, and 86% for SA group and 89.6%, 83.2%, and 71.8% for MA group. There was a higher percentage of graft loss from chronic allograft nephropathy in MA group than in SA group (16.7% vs. 5.5%, P=0.01). The presence of MA (vs. SA) was an independent risk for acute rejection (OR 3.60, 95% CI 1.59-8.14, P=0.002) and for graft loss (HR 2.31, 95% CI 1.05-5.09, P=0.038). Laparoscopic procurement of living donor kidneys with SA may be associated with a lower risk of rejection, better function, and superior long-term survival when compared with kidneys with MA.