Living donor kidney transplantation with multiple arteries: Recent increase in modern era of laparoscopic donor nephrectomy

Objective: To compare the outcome of living donor kidney transplantation using allografts with a single artery with that observed in recipients of allografts with multiple arteries. Design: Retrospective analysis. Setting: Tertiary center. Patients: Three hundred fifty patients who underwent living donor kidney transplantation from January 2000 to March 2007. Interventions: Living donor kidney transplantation. Main Outcome Measures: Surgical complications and allograft survival. Results: Three hundred nineteen allografts (91.1%) had a single artery (group 1) and 31 (8.9%) had multiple arteries (group 2), including 2 arteries in 21 grafts (67.8%), 3 arteries in 6 (19.3%), and 4 arteries in 4 grafts (12.9%). The operative time was shorter in group 1 compared with group 2 (mean [SD], 173 [35] vs 259 [48] minutes; P<.001). The overall surgical complication rate in groups 1 and 2 was comparable (9.6% vs 9.7%; vascular, 2.8% vs 3.2%; urological, 1.6% vs 3.2%; symptomatic lymphocele, 2.8% vs 3.2%; and wound infections, 2.8% vs 3.2%). The actuarial 1- and 5-year allograft survival rates were comparable in both groups (98.4% and 91.5% in group 1 and 96.8% and 87.1% in group 2). A significant increased use of allografts with multiple arteries has been observed in recent years: 7.8% (n=10) in grafts that were procured by open technique (n=127), 4.1% (n=5) during our initial experience with laparoscopic nephrectomy (n=123), and 16% (n=16) in the most recent 100 cases (P<.01). Conclusions: Living donor kidney transplantation in the presence of multiple renal arteries is feasible and safe. Additionally, graft survival and graft function are not adversely affected by the presence of multiple renal arteries in grafts procured laparoscopically. Recently, there has been an increased use of kidneys with multiple arteries with excellent results.