Abstract
BACKGROUND: The use of kidneys with multiple arteries (MAs) in living donor transplantation expands the donor pool. However, when accessory arteries are of small caliber or recipient iliac atherosclerosis is significant, reimplantation may not be feasible. Our objective was to assess renal consequences of accessory arteries sacrifice. METHODS: This single-center retrospective study included 251 consecutive living donor kidney transplants performed between April 2019 and June 2023. Patients were classified into three groups: single artery (SA), multiple arteries with full preservation (MAP), and multiple arteries without reimplantation (MAWR). Accessory arteries caliber and location, early and late complications, graft survival, renal function, and transplant imaging features were compared between groups. RESULTS: Comparing MAWR (N = 23) and MAP (N = 45), accessory renal arteries were more sacrificed when supplying upper pole (63% vs. 15%), mean main artery diameter was larger (5.65 mm vs. 4.78 mm, p < 0.01), and mean accessory artery diameter was smaller (1.91 mm vs. 3.11 mm, p < 0.01). No difference in early or late complication or allotransplant survival was observed among SA (n = 183), MAP, or MAWR. We found no significant difference in renal function at 7 days (p = 0.96), 6 months (p = 0.72), or 12 months (p = 0.24) post transplantation as compared with SA or MAP, despite presence of limited perfusion defect on ultrasound in MAWR recipients. CONCLUSION: In selected cases, sacrifice of accessory renal arteries not amenable to reimplantation in living donor kidney transplantation was not associated with renal transplant impairment or any clinical negative outcome. Our study also emphasizes that kidneys with MAs should not be excluded from living donation.