Vascular Variations and Anastomosis Techniques in Renal Transplant Donors

Year 2015, , 542 - 546, 30.09.2015

İlker Arer , Hakan Yabanoğlu Kenan Çalışkan Alper Parlakgümüş Sedat Yıldırım Gökhan Moray Mehmet Haberal

https://doi.org/10.17826/cutf.25364

Abstract

Purpose: We aimed to share our experience about vascular variations and anastomosis tecniques in renal transplant donors. Material and Methods: 128 donor nephrectomy performed in our hospital between February 2010 and June 2014 were included in our study. Donors were retrospectively analyzed according to age, sex, comorbidity, operation history, site of nephrectomy, vascular variation and anastomosis techniques. Results: 21 (%16,4) patients have left-sided, 19 (%14,8) have right-sided and 13 (%10,2) have bilateral vascular variation. 29 (%21,2) unilateral double renal artery, 8 (%6,3) unilateral double renal artery and vein, 4 (%3,2) unilateral triple renal artery, 3 (%2,4) early branching renal artery, 2 (%1,6) unilateral double renal vein and 2 (%1,6) polar artery are vascular variations observed. of 92 (%71,9) recepients anastomosis type was end to side between renal artery and external iliac artery and end to side between renal vein and external iliac vein, 32 (%25) end to end between renal artery and external iliac artery and end to side between renal vein and external iliac vein, 4 (%3,1) end to side between renal artery and external iliac artery and end to side between renal vein and external iliac vein and end to side between 2nd renal artery and external iliac artery. Conclusion: Preoperative evaluation of renal vasculature of transplant donors is an important issue in means of decreasing peroperative vascular complications and decision for nephrectomy site.

Keywords

Donor nephrectomy, vascular variation, anastomosis

Böbrek Transplantasyon Donörlerinde Vasküler Farklılıklar ve Anastomoz Teknikleri

Abstract

Amaç: Donör nefrektomileri vasküler farklılık ve anastomoz teknikleri açısından inceleyerek bu konudaki tecrübelerimizi paylaşmayı amaçladık. Materyal ve Metod: Şubat 2010 ile Haziran 2014 tarihleri arasında merkezimizde donör nefrektomi ameliyatı yapılan 128 hasta dahil edildi. Donörler yaş, cinsiyet, ek hastalık, geçirilmiş ameliyat varlığı, donör nefrektomi yapılan taraf, vasküler farklılık ve anastomoz tekniği açısından geriye dönük olarak incelendi. Bulgular: Hastaların 21 (%16,4)’ünde solda, 19 (%14,8)' da sağda ve 13 (%10,2)'ünde bilateral vasküler farklılık mevcuttu. Saptanan vasküler farklılıklar ise sırasıyla; hastaların 29 (%21,2)' da unilateral çift renal arter, 8 (%6,3)' de unilateral çift renal arter ve çift renal ven, 4 (%3,2)' de unilateral üç renal arter, 3 (%2,4)' de erken dallanan renal arter, 2 (%1,6)' de unilateral çift renal ven, 2 (%1,6)' de polar arterdir. Vasküler anastomoz tipi ise; 92 (%71,9) renal transplantasyon hastasında renal ven ile eksternal iliyak ven arasında uç-yan ve renal arter ile eksternal iliyak arter arasında uç-yan, 32 (%25) hastada renal ven ile eksternal iliyak ven arasında uç-yan ve renal arter ile internal iliyak arter arasında uç-uca iken 4 (%3,1) hastada renal ven ile eksternal iliyak ven arasında uç-yan, renal arter ile eksternal iliyak arter arasında uç-yan ve 2. renal arter ile internal iliyak arter arasında uç-uca yapılmıştır. Sonuç: Böbrek transplantasyonunda ameliyat öncesi donörlerin vasküler farklılıklarının incelenmesi hem nefrektomi yapılacak böbreğin seçiminde hem de ameliyat sırasında diseksiyon yaparken vasküler anatomiye hakim olarak komplikasyonu azaltmada etkisi olacağından ciddi önem taşımaktadır.

Keywords

Donör nefrektomi, vasküler varyasyon, anastomoz

References

• Tropman C, Wiesman K, McVicar JP, Wolfe BM, Perez RV. Increased transplantation of kidneys with multiple renal arteries in the laparoscopic live donor nephrectomy era: Surgical technique and surgical and nonsurgical donor and recipient outcomes. Arch Surg. 2001;136:897-907.
• Rydberg J, Kopecky KK, Tann M et al (2001) Evaluation of prospective living renal donors for laparoscopic nephrectomy with multisection CT: the marriage of minimally invasive imaging with minimally invasive surgery. RadioGraphics. 2001;21:223–36.
• Chabchoub K, Mhiri MN, Bahloul A, Fakhfakh S, Ben Hmida I, Hadj Slimen M et al. Does kidney transplantation with multiple arteries affect graft survival? Transplant Proc. 2011; 43:3423–3425.
• Yildirim M, Kucuk HF. Outcomes of renal transplantations with multiple vessels. Transplant Proc. 2011;43:816–8.
• Haberal M, Karakayali H, Bilgin N, Moray G, Arslan G, Büyükpamukçu N, Four-quadrant running-suture arterial transplantation: a preliminary report. Transplant Proc. 1996;28:2334-5. technique in renal
• Arévalo Pérez J, Gragera Torres F, Marín Toribio A,
• Koren Fernández L, Hayoun C, Daimiel Naranjo I. Angio CT assessment of anatomical variants in renal vasculature: its importance in the living donor. Insights Imaging. 2013;4:199-211.
• Giessing M, Kroencke TJ, Taupitz M et al. Gadolinium enhanced three-dimensional magnetic resonance angiography versus conventional digital subtraction angiography: which modality is superior in evaluating living kidney donors? Transplantation. 2003:76:1000.
• Sussman SK, Weinerth JL, Braun SD et al. Intravenous digital subtraction angiography in the evaluation of potential renal donors. J Urol. 1987;138:28.
• Rankin SC, Jan W, Koffman CG. Noninvasive imaging of living related kidney donors: evaluation with CT angiography and gadolinium-enhanced MR angiography. AJR Am J Roentgenol. 2001:177:349.
• Gluecker TM, Mayr M, Schwarz J, Bilecen D, Voegele T, Steiger J, Bachmann A, Bongartz Comparison of CT angiography with MR angiography in the preoperative assessment of living kidney donors. G. Transplantation. 2008;86:1249-56.
• Pollak R, Prusak BF, Mozes MF. Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation. Am Surg. 1986;52:233.
• Platt JF, Ellis JH, Korobkin M, Reige K. Helical CT evaluation of potential kidney donors: findings in 154 subjects AJR Am J Roentgenol. 1997;169:1325-30.
• Zhang JQ, Hu XP, Wang W, Li XB, Yin H, Zhang XD. Multidetector row-CT in evaluation of living renal donors Chin Med J. 2010;123:1145-8.
• Chai JW, Lee W, Yin YH, Jae HJ, Chung JW, Kim HH, et al. CT angiography for living kidney donors: accuracy, cause of misinterpretation and prevalence of variation. Korean J Radiol. 2008;9:333-9.
• Raman SS, Pojchamarnwiputh S, Muangsomboon K, Schulam PG, Gritsch HA, Lu DSK. Utility of 16- MDCT angiography for comprehensive preoperative vascular evaluation of laparoscopic renal donors. Am J Roentgenol. 2006;186:1630-8.
• Kawamoto S, Montgomery RA, Lawler LP, Horton KM, Fishman EK. Multidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors. Am J Roentgenol. 2003;180:1633-8.
• Kock MC, Ijzermans JN, Visser K, Hussain SM, Weimar W, Pattynama PM, Krestin GP, Hunink MG. Contrast-enhanced MR angiography and digital subtraction angiography in living renal donors: diagnostic agreement, impact on decision making, and costs. AJR Am J Roentgenol. 2005;185:448-56.