14例亲属活体供肾动脉变异的血管重建

目的 探讨亲属活体供肾动脉变异的血管重建方法.方法 在104例亲属活体供肾移植中,有14例供肾动脉变异.供肾动脉变异的分类和血管重建方法分别为:(1)单支动脉较早分支型2例,取肾时分支受损,分别用受者髂内动脉及其分支、腹壁下动脉离体重建受损动脉.(2)双支动脉型10例,4例用受者髂内动脉及其分支离体重建血管,3例用受者腹壁下动脉与较细分支于体内吻合,1例较短肾动脉与较长肾动脉端侧吻合,1例较细副.肾动脉与主肾动脉端侧吻合,1例双支分别与髂外动脉端侧吻合.(3)3支动脉型2例,1例用受者髂内动脉及分支离体重建血管,1例结扎细小分支后,将较细的副肾动脉与主肾动脉端侧吻合.14例血管重建后,分别将供肾动脉较粗支和/或髂内动脉主干端与受者髂外动脉端侧吻合.结果 术后各支动脉血流通畅,移植.肾血液供应丰富、均匀.12例肾功能早期恢复正常,其中1例术后第14天发生急性排斥反应.1例术后即发生急性排斥反应;1例血肌酐下降缓慢.随访至2008年7月,除1例动脉粥样硬化较重的受者(三支动脉)下极动脉栓塞,血肌酐升高并稳定在170μmol/L外,其余患者动脉血流通畅,血液供应丰富、均匀.结论 供肾动脉变异时,利用所得供肾动脉的自身条件重建血管,或用受者髂内动脉及分支或腹壁下动脉重建血管,可获得较好的移植肾功能.受者动脉粥样硬化较重,同时有较细肾动脉支做重建吻合时,应注意该支动脉发生栓塞的可能.     

探讨肾动脉多支畸形的供肾在体外血管重建中的方式及在肾移植中的应用

目的探讨。肾动脉多支畸形的供。肾在体外血管重建中的方式及其在肾移植中的应用。方法对5例肾动脉多支畸形供肾的修整采取截取受者同侧髂内动脉的方法，依据供肾动脉的分支数而保留髂内动脉的分支数；在体外将供肾动脉各分支与髂内动脉大分支的开口进行端端吻合，然后将髂内动脉主干与受者髂外动脉行端侧吻合。将肾动脉重建后的供肾应用于双侧肾动脉瘤患者的自体肾移植术1例、亲属活体供肾肾移植术3例和尸体肾移植术1例。结果术后5例受者均未发生外科并发症。1例术后发生短暂的急性。肾小管坏死，但48h后进人多尿期，肾功能恢复顺利。术后随访10-36个月，受者移植。肾功能全部正常，肾动脉及分支未发生血栓或闭塞。结论采用受者的髂内动脉体外重建供。肾动脉的方法，可有效修复肾动脉3支以上以及。肾动脉过短的供肾，是一种安全可行的血管重建的方法，血管并发症较低，可有效应用于肾移植。     

亲属活体肾移植供肾多支动脉变异的血管重建

目的多支动脉供肾是亲属活体供肾移植手术的难点，探讨多支动脉供肾手术中的血管重建方法。方法2006年4月-2008年3月，实施亲属活体肾移植77例，其中单支动脉型供肾组63例，多支动脉型供肾组14例。14例多支动脉型供肾，左肾9例，右肾5例，其中2支动脉变异者11例，3支动脉变异者3例。所有供、受者手术前常规行淋巴细胞毒交叉试验、人类白细胞抗原配型等检查。供者取肾手术采取经12肋腰部切口取肾，对多支动脉型右侧供肾，采取在腔静脉后方游离肾动脉。受者植肾手术采取经典的下腹部大L型切口将移植肾置于髂窝内。多支动脉型供肾组移植肾动脉采取分别与髂内动脉和／或髂外动脉吻合。结果多支动脉型供肾组14例供肾者术中均未输血，术后7～9d出院，无任何并发症。随访3个月～1年，肾功能、血压及尿常规完全正常。术后受者均无急性肾小管坏死、肾血管栓塞、肾动脉狭窄、尿瘘、输尿管坏死等并发症，彩色超声检查示移植肾血供均良好。与单支动脉供肾组比较，多支动脉型供肾组受者吻合血管开放后开始泌尿时间、术后第1周的平均血肌酐、平均动脉压、住院时间差异均无统计学意义（P〉0．05）。结论正确处理活体供肾多支动脉是活体肾移植安全的保证。     

门静脉回流式肠道引流的同侧胰肾联合移植术四例

目的 改进门静脉回流式肠道引流的胰肾同侧联合移植术的动脉重建方法.方法 供者采用肝胰肾脾联合切取法,并切取供者髂血管备用.修整供者器官时,将肝总动脉与胃十二指肠动脉端端吻合,以重建胰十二指肠动脉弓;将髂总静脉与门静脉端端吻合,以延长门静脉1～2 cm;将髂外动脉与肠系膜上动脉和腹腔干共同的腹主动脉袖片行端端吻合,备用.胰腺移植时,将供者延长后的门静脉与受者肠系膜上静脉行端侧吻合,将供者髂总动脉及髂内动脉经末端同肠系膜打孔穿出后,供者髂总动脉与受者髂外动脉行端侧吻合,供者髂内动脉用血管夹暂时夹闭,准备与供肾动脉吻合.供者十二指肠与受者空肠用吻合器行侧侧吻合.肾移植时,将供肾静脉与受者髂外静脉行端侧吻合,肾动脉与夹闭备用的供者髂内动脉行端端吻合,开放肾血流后,将移植肾经切口置于右下腹部侧腹膜外同定,并在腹膜外吻合输尿管与膀胱.结果 除1例术后第50天时因腹腔感染导致多器官功能衰竭而死亡外,其他3例术后均恢复顺利.术后对3例存活患者随访了24～27个月,患者移植物功能良好,完全停用胰岛素,血清肌酐为72.5～119.7μmol/L.结论 门静脉回流式肠道引流的胰肾同侧联合移植术较传统术式操作简单,而十二指肠动脉弓的重建改善了胰腺及十二指肠的血液供应.术中利用供者髂总动脉搭桥,将供肾动脉吻合到供者髂内动脉的术式可以减少在受者严重钙化的周围血管上的操作次数,同时为患者保留了左侧髂动脉.     

亲属活体供肾移植中副肾动脉的重建

目的 探讨亲属活体供肾移植中利用受者腹壁下动脉(IEA)重建供肾副肾动脉(ARA)的临床效果.方法 存在ARA的亲属活体供肾16个,其中单支型15个,多支型1个.5个供肾的ARA位于上极,1个位于中部,9个位于下极,1个供肾的中部和下极各有一支ARA,其开口直径为1.5～3.5 mm.供肾热缺血时间为1～6.5 min,冷缺血时间为15 90 min.除多支型1例的中部ARA与肾动脉主干行端侧吻合外,其余16支ARA均与受者的IEA重建.ARA位于上极的5个供肾中,3个由于ARA过短,而供肾因为输尿管原因又不适于颠倒以与IEA重建,遂切取一段长3～6cm的供者生殖腺静脉,对ARA进行延长,再将ARA与IEA进行重建.术后采用多普勒超声检查移植肾血流,监测血清肌酐(Cr).结果 所有IEA与ARA的吻合均一次完成,吻合时间为(4.9±1.4)min,开放IEA后,见IEA和ARA均搏动良好,吻合口通畅.仅2例术中发生吻合口漏血,经热盐水纱布轻压局部2～3 min后出血停止.术后第3天,多普勒超声检查显示,16例移植肾的ARA供血区域血流丰富,局部动脉阻力指数正常(<0.7).所有肾脏均在恢复血液供应后10 min内开始泌尿,术后血清Cr均迅速下降至正常.16例未发现下肢血管并发症的发生.术后随访6个月,未见局部动脉栓塞,也无输尿管坏死发生.结论 对于存在ARA的供肾,可利用受者的IEA进行重建,此术式适用于ARA与肾动脉主干或其他动脉吻合存在困难者.     

肾移植活体供者术前多层螺旋CT检查的价值

目的 探讨多层螺旋CT(MSCT)在肾移植活体供者术前检查中的应用价值.方法 采用MSCT对11例受检者进行双侧肾脏及全尿路增强扫描,观察原始图像并对原始数据进行后处理,评估肾脏血管解剖变异、肾实质和收集系统的情况.结果 MSCT清晰显示了肾脏和全尿路,11例受检者22个肾脏中,发现肾脏副肾动脉7支、肾主肾动脉早期分支5支、10支肾动脉由单一动脉供血;22支肾静脉未见异常,均为1支肾静脉;存在肾囊肿1例,肝左叶海绵状血管瘤1例;10例肾实质形态和集合系统均未见异常.7例供者行供肾摘除术,术中所见供肾血管情况与MSCT术前评估结果一致.结论 MSCT应用增强扫描能较好显示受检者肾脏血管变异、肾实质形态和肾脏收集系统情况,可作为肾移植活体供者术前评估的重要方法.     

活体肾移植供肾多支血管处理的体会

目的探讨活体肾移植供肾多支血管的处理及重建方法。方法 49例供体,供肾有多支动脉变异45例,有多支静脉变异7例,其中3例为肾动脉、静脉同时多支血管变异。供肾切取术中,对于供血面积直径小于3cm且影响操作的分支动脉,术中即予结扎、离断;多支静脉,如直径为主干的1/3以下且试夹闭该静脉未发现明显淤血等血液回流障碍者,给予结扎、离断。5例采用体外血管重建。受体肾移植术中根据分支动脉管径、长度及位置及受者髂动脉和腹壁下动脉的情况等综合条件来选择受者相应的动脉吻合。结果 48例动脉分支吻合者在开放血流后搏动良好、吻合口通畅,术后1～7d内肾功能恢复正常、术后1～2周彩色多普勒超声检查,提示该分支动脉供血区域丰富。肾静脉分支结扎者未发现淤血现象。1例高龄供肾者发生肾功能延迟恢复。术后无出血、肾动脉栓塞、尿瘘、输尿管坏死和新发高血压等并发症。结论正确处理移植肾多支血管变异,可获得良好移植效果。     

多层螺旋CT在活体肾移植供肾评估及取肾手术方式选择中的应用

目的 评价多层螺旋CT(MSCT)在活体肾移植供肾及取肾手术方式选择中的应用价值.方法 90例活体肾移植供者接受了MSCT平扫及动脉期、静脉期和排泄期的扫描.采用最大密度投影和容积再现技术进行血管成像,所有MSCT图像均由2位影像医师盲法下独立进行分析和评价.根据重建的CT图像,影像医师与肾移植医师进行讨论,选择左肾还是右肾作为供肾,并确定采用腹腔镜下取肾手术或是开放式取肾手术.结果 90例供者中,78例接受了左肾切取术,其中71例左侧供肾无明显变异者接受了常规腹腔镜下取肾手术,7例两侧肾脏均存在如副肾动脉、多支肾静脉,或者肾静脉位于腹主动脉后方等较明显变异,接受了左肾开放式取肾手术;12例因左肾存在明显变异,接受了右肾切取术,均行手辅助腹腔镜下取肾手术.所有术中记录的肾血管及集尿系统的解剖结构与术前MSCT评价一致,其准确率为100％.2位影像医师在评价肾动脉、肾静脉和集尿系统中显示了很好的一致性.90例取肾手术全部成功,移植术后受者未发生肾静脉血栓形成等血管并发症.结论 MSCT作为活体肾移植供者术前评价“一站式”检查方法,可以为供肾和取肾手术方式的选择提供准确、有价值的信息.     

活体肾移植供肾动脉解剖学特点及其处理的临床体会

目的 总结活体肾移植供者肾动脉解剖学特点及多支动脉供肾的手术处理方式.方法 分析我中心142例活体肾移植供者术前数字减影血管造影和CT血管成像的供肾动脉解剖结果.用6种不同方式对多支动脉供肾进行显微技术处理,比较供肾多支动脉受者(n=31)与供肾单支动脉受者(n=111)术后早期的临床疗效.结果 30.99%的供者存在肾脏多支动脉,两侧肾脏相似(左肾22.54%,右肾22.13%),在一侧存在时,对侧也存在的概率分别为56.25%和60.00%.左肾动脉主干稍粗(P=0.001)且主干上第1个分支距腹主动脉距离稍近(P=0.004).多支动脉组受者手术时间和供肾冷、热缺血时间延长,但在术中出血量、移植肾功能延迟恢复、急性排斥反应及移植肾彩超弓形动脉流速等方面与单支动脉组差异并无统计学意义.在术后7 d、1个月、3个月3个观察点2组受者血清肌酐和肌酐清除率相似,重复测量的方差分析还表明供肾是否为多支动脉对术后早期肾功能的变化趋势并无影响.结论 充分了解活体供肾的动脉解剖并采用正确的处理方式是保证移植效果的重要因素.     

多层螺旋CT在活体肾移植供者术前评估中的作用

目的 探讨多层螺旋CT(MELt)在活体肾移植供者术前评估中的作用.方法 对104名活体供肾者术前肾脏MDCT检查的资料进行回顾性分析.均采用64层螺旋CT检查,对双肾进行非增强扫描,注射造影剂后分别行动脉、静脉和排泄期增强扫描,扫描范围从膈顶到耻骨联合.扫描完后重建MDCT图像.根据MDCT图像,记录供者肾脏、输尿管、肾动脉及肾静脉的解剖结构和变异情况,并以供肾切取术中被证实的情况作为标准,对比分析术前MDCT检查对供肾的评估作用.结果 104名供者成功完成MDCT检查,肾脏和输尿管异常者8例.除外1例蹄铁型肾,副肾动脉和肾动脉过早分支的发生率分别为27.2%(28/103)和12.6%(13/103),有双肾静脉者3例,左肾静脉位于腹主动脉之后者3例.共有93名供者成功接受供肾切取术,术中证实,术侧供肾和输尿管异常与术前MDCT检查结果一致;术侧副肾动脉的检出率为80%.直径大于1 mm的副肾动脉和肾动脉过早分支术前均被MDCF检出;肾静脉均与术前MDCT检查结果一致.结论 活体供肾切取前采用MDCT检查能准确显示肾脏的解剖结构和血管变异情况,对供者选择及手术方案的制定具有重要意义.     

Successful renovascular reconstruction for renal allografts with multiple renal arteries

BACKGROUND: Kidney grafts with multiple renal arteries have been considered a relative contraindication because of the increased risk of complications. In the present study, we retrospectively reviewed multiple renal artery reconstruction in kidney transplantation to elucidate the usefulness of these grafts. METHODS: From January 1997 until August 2001, 431 recipients underwent kidney transplantation at our institution; 393 patients are reviewed. The surgical techniques of vascular reconstruction and short-term outcome are reported. The living kidney transplant recipients were divided into vascular reconstructed and nonreconstructed groups, and mean serum creatine levels, warm and total ischemic times, and incidences of acute rejection and posttransplantation hypertension were compared. RESULTS: We noted multiple renal arteries in 96 (24.4%) of the 393 grafts. Arterial reconstruction was performed on 53 (13.5%) grafts, whereas 43 (10.9%) small polar arteries were simply ligated. Surgical management of the multiple arteries was variable. The most common reconstruction was conjoined anastomosis (17 cases) between two arteries of equal size and end-to-side anastomosis (14 cases) of smaller arteries to larger arteries. In nine cases, autogenous hypogastric or epigastric artery grafts were used to reconstruct multiple renal arteries. Multiple anastomosis was performed in six cases. In seven cases, complicated surgical vascular reconstruction was performed. The mean total ischemic times in the reconstructed and nonreconstructed groups were 102.6 and 71.0 min, respectively (P<0.01). The incidences of posttransplantation hypertension in the reconstructed and nonreconstructed groups were 68.2% (30/44) and 48.6% (141/290), respectively (P<0.05). There was no significant difference between the reconstructed and nonreconstructed groups in mean warm ischemic times, mean creatinine levels, and incidences of acute rejection. CONCLUSIONS: Allografts with multiple renal arteries can be used successfully in kidney transplantation.     

大鼠肾移植模型手术改良技巧探讨

目的探讨大鼠肾移植模型手术的改良方法。方法供体Sprague-Dawley(SD)大鼠21只,受体Wistar大鼠42只。采用双侧供肾。受体左肾切除后借助自制导管,行受体肾动脉与供体肾动脉、受体肾静脉与供体下腔静脉端端吻合,供体输尿管带膀胱瓣与受体膀胱吻合,最后切除右肾,腹腔内注入头孢米诺10 mg,关腹。记录手术时间,动、静脉吻合时间,冷、热缺血时间等手术数据;术后大鼠存活3 d认为模型建立成功,计算建模成功率,分析死亡原因。结果供体手术时间为(32.7±5.6)min,供肾修整时间为(4.2±1.1)min。受体手术时间为(42.3±4.9)min,其中动脉吻合时间为(10.1±3.2)min,静脉吻合时间为(13.9±2.5)min,尿路重建时间为(6.3±1.4)min。热缺血时间为(5.4±1.8)s,冷缺血时间为(56.2±7.3)min。42只受体大鼠中,建模成功40只,成功率为95%。另2只受体大鼠死亡,其中1只死于血管吻合口出血,1只死于尿瘘引致的腹膜炎。结论采用改良的血管端端吻合法建立大鼠肾移植模型具有操作简单、手术时间短、成功率高的特点。     

肾动脉内套法建立大鼠肾移植模型

目的探索一种操作简单、成功率高的建立大鼠肾移植模型的手术方法。方法选择SD大鼠24只作为供体,Wistar大鼠48只作为受体,采用。肾动脉内套法建立大鼠。肾移植模型。所有受体大鼠均接受左侧原位肾移植,自体右肾切除。受体大鼠动脉重建借助自制动脉套管将受体肾动脉内套人供肾动脉,缝线固定及3点外膜加固行肾动脉重建,受体肾静脉与供体后腔静脉借助自制导管行端一端吻合,尿路改建采用供体输尿管膀胱瓣与受体膀胱吻合。结果研究共实施48例大鼠肾移植术。24只供体大鼠平均手术时间（354±6）min,供肾修整时间（3．9±1．2）rain,供肾热缺血时间（5．7±1．5）s,冷缺血时间（52±6）rain。48只受体大鼠手术时间（39±6）min,动脉吻合时间（6．9±2．5）min,静脉吻合时间（14．2±2．3）min,尿路重建时间（6．6±1．1）min。术后3d内,2只大鼠因血管吻合口出血死亡,2只因移植肾动脉内血栓形成死亡,1只因尿瘘致腹膜炎死亡,其余43只大鼠均获手术成功,成功率89．6％。截至术后14d,共7只受体大鼠存活,所有受体大鼠中位存活时间6d10结论肾动脉内套法操作简单,受体大鼠成功率高,初学者掌握快,易于推广。     

The long-term outcomes of transplantation of kidneys with multiple renal arteries

Kidneys with multiple renal arteries are increasingly procured for transplantation. To compare the outcomes of kidney transplantation using allografts with multiple arteries, we studied long-term graft function and survival according to their number of arterial anastomoses during an 18-year period from July 1, 1990, through December 31, 2008, in which only the recipient's external iliac artery or internal iliac artery was used for anastomosis (n = 1186). The recipients were divided into four groups: group I, single renal artery with single anastomosis (n = 890, 75.0%); group Il, multiple renal arteries, single anastomosis (n = 26, 2.2%); group Ill, multiple renal arteries, multiple anastomoses (n = 236, 19.9%); and group IV, polar artery ligation (n = 34, 2.9%). We compared the following variables patient and graft survivals; mean creatinine levels at 1 and 6 months, as well as 1-, 3-, and 5-years posttransplant; the number of acute rejection episodes, and the rates of vascular and urologic complications. The creatinine values and incidences of acute rejection episodes did not differ significantly (P = 0.399 and P = 0.990, respectively). There were no significant differences among the four groups in graft survival (P = 0.951), patient survival (P = 0.751), incidence of vascular (P = 0.999) or urologic complications (P = 0.371). The four groups were subdivided according to the recipient arterial anastomosis to the main graft renal artery. The subdivided groups showed no significant differences in graft or patient survival, or complications rates. The results indicated that multiplicity of renal arteries in kidney transplantation did not adversely affect allograft or patient survival compared with single renal artery transplantation. Moreover, the type of the arterial anastomosis (main renal artery end-to-end anastomosed to internal iliac artery or end-to-side anastomosed to external iliac artery appeared to not affect graft or patient survival or the incidence of vascular or urologic complications.     

Reconstruction of Multiple Renal Arteries During Simultaneous Pancreas and Kidney Transplantation: A Case Report

We present a case of a multiple renal artery reconstruction during simultaneous pancreas and kidney transplantation. The kidney graft had 6 renal arteries, the aorta patch was 10 cm long, and there were two renal veins. To perform anastomoses to the left external iliac vessels we had to reconstruct the renal arterial and venal patches. The results of the transplantation were very good. Both grafts had satisfactory function, even though a control computed tomography performed a year after transplantation revealed infarction of a lower renal pole. Anatomical anomalies should not be a contraindication for transplantation, although transplants involving a multiplicity of vessels is a challenge for surgeons and requires both knowledge and microsurgical skills.     

跖-掌血管吻合急诊再造手指

目的：探讨采用跖-掌血管吻合游离足趾急诊再造手指的方法和疗效。方法2007年2月-2012年4月,对48例56指毁损的患者采用跖-掌血管吻合（即足部的第1跖骨背动脉或趾固有动脉与指总动脉吻合,跖背静脉与掌背静脉吻合）的方法,游离第2足趾急诊修复再造手指。结果术后48例56指全部成活,成活率100%,术后随访6个月～3年,再造指指腹饱满血运良好,依据中华医学会手外科学会拇手指再造功能评定试用标准评定,再造手指优51指,良3指,可2指,优良率91%。结论对于食中环指的Ⅳ＆#176;、Ⅴ＆#176;、Ⅵ＆#176;缺损应用跖-掌血管吻合急诊修复再造是简捷可靠的方法。     

Trasplante renal mediante reconstrucción de conducto vascular en riñones de donantes fallecidos con arterias renales múltiples y venas renales cortas

BackgroundTransplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications.Patients and methodsWe performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient.ResultsNo post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation.ConclusionsVascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants.     

Reconstruction of a Transplant Recipient’s External Iliac Artery Using Donor’s Inferior Vena Cava in Renal Transplantation: 2 Case Reports

Iliac atherosclerosis is common in renal transplant recipients. In severe cases, it affects intraoperative renal arterial anastomosis and increases the risk of postanastomosis complications. At present, safe and efficient vascular replacement methods are relatively limited. In the 2 renal transplant cases at our center, described here, the donors’ iliac arteries were unavailable. We therefore attempted to replace the recipients’ diseased external iliac artery with the donors’ inferior vena cava and then performed an end-to-side grafting with the attachment in arterial reconstruction. One patient received a single kidney transplantation, while the other received a dual kidney transplantation. Antiplatelet/anticoagulation drug application was avoided, and both patients were observed for more than 6 months. Stable renal graft function was achieved without any vascular complications. During this study, all procedures were in compliance with the Helsinki Congress and the Declaration of Istanbul. For end-stage renal disease patients with severe iliac atherosclerosis who are waiting for kidney transplantation, a donor’s vena cava graft could potentially be a promising replacement option to restore external iliac artery patency and reconstruct renal blood flow, without the necessity of harvesting a recipient’s autologous vessels or looking for costly artificial ones.     

Microvascular surgery in experimental and clinical kidney transplantation

An improved microsurgical technique for orthotopic rat kidney transplantation is described in detail. (1) End-to-end anastomosis of renal arteries with 7-8 interrupted 10-0 sutures. (2) End-to-end anastomosis of renal veins with 2 continuous semicircular 10-0 sutures. (3) Non-splinted end-to-end ureteric anastomosis with 4 interrupted full-thickness 11-0 sutures. (4) Simultaneous bilateral nephrectomy. Seventy transplantations were analysed. No failure due to complications of the vascular anastomoses occurred. The ureteric anastomoses were complicated by stenosis in only 5 animals (7%). The operation times for vascular anastomoses were 20 (15-24) minutes and for complete transplantation 50 (45-60) minutes. This technique seems to be less time consuming than other methods. Our method has produced a success rate of 93% with well standardized and reproducible organ quality. Preliminary clinical experiences with extracorporeal microvascular reconstruction in 4 cases of injured small polar kidney allograft arteries support the continued application in appropriate situations to increase the number of suitable donor kidneys.