Best results in living donor transplantation using an aggressive policy in microsurgical bench reconstruction of nonoptimal arterial supply

The increasing of number of patients awaiting kidney transplantation have forced surgeons to use nonoptimal organs, such as kidneys with multiple/diseased arteries as well as those coming from living donors (LDs). Two hundred and sixty six LD transplants performed in cyclosporine era included 44 coming from a LD over 60 years of age. They were categorized into three groups according to the number of renal arteries and the surgical techniques employed for the arterial anastomosis: group I (n = 213) had a single "normal" renal artery. Group II (n = 11) were grafts with two (n = 10) or three (n = 1) arteries, which were directly reconstructed by intracorporeal conventional separate anastomoses. Group III of 42 recipients had grafts with either one artery affected by intrinsic renovascular disease (n = 18) or multiple arteries (n = 24) that were reconstructed at the bench. Recipient survival at 1 year was comparable, namely, 98%, 100%, and 100% rates in groups I, II, and III, respectively. Graft survivals not censored for death were 87%, 85%, 100% at 3 years for groups I, II, and III, respectively. The use of microvascular reconstructions ex vivo can widen the criteria for acceptance of LDs who display multiple or diseased renal arteries.