| Summary: | Background/Aim. Multiple renal arteries (MRAs) represent a surgical challenge
by the difficulty in performing anastomoses, bleeding and stenosis. MRAs
should be preserved and special attention should be paid to accessory polar
arteries. All renal arteries (RAs) must be reconstructed and prepared for
safe anastomosis. The paper decribed the different techniques of vessel
reconstruction during kidney transplantation including important steps within
recovery of organs, preparation and implantation. Methods. In a 16-year
period (1996-2012) of kidney transplantation in the Military Medical Academy,
Belgrade, a total of 310 living donors and 44 human cadaver kidney
transplantations were performed, of which 28 (8%) kidneys had two or more
RAs. Results. All the transplanted kidneys had immediate function. We
repaired 20 cases of donor kidneys with 2 arteries, 4 cases with three RAs,
one case with 4 RAs, one case with 4 RAs and renal vein reconstruction, one
case with 3 arteries and additional polytetrafluoroethylene (PTFE) graft
reconstruction, one case with transected renal artery and reconstruction with
5 cm long deceased donor external iliac artery. There were no major
complications and graft failure. At a minimum of 1-year follow-up, all the
patients showed normal renal function. Conclusion. Donor kidney
transplantation on a contralateral side and “end-to-end” anastomosis of the
renal artery to the internal iliac artery (IIA) is our standard procedure
with satisfactory results. Renal artery reconstruction and anastomosis with
IIA is a safe and highly efficient procedure and kidneys with MRAs are not
contraindicated for transplantation. A surgical team should be fully
competent to remove cadaveric abdominal organs to avoid accidental injuries
of organs vessels.
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