Comparative analysis of live donor kidney transplantation in double renal arteries with 30/70 lumen discrepancy using Pajama Bench reconstruction versus end to side reconstruction and separate implantation technique
Anant Kumar1, Amit A. Bansal1, Devanshu Bansal1, Pragnesh Desai1, Samit Chaturvedi1, Ruchir Maheshwari1.
1Urology, Uro-oncology, Robotics and Renal Transplantation, Max Healthcare, New Delhi, India
Introduction: Live donor kidney transplantation in multiple donor vessels is technically challenging and anastomoses of each multiple vessel separately causes prolonged rewarm ischemia time. However, bench reconstruction of vessels minimizes the rewarm ischemia and is supposed to be better. We compared the outcomes of bench reconstruction in pajama fashion versus end to side reconstruction and separate implantation of vessels in cases of double renal arteries with lumen discrepancy of 30/70.
Materials and Methods: Seven hundred and eighteen patients of live renal transplantation were analyzed from January 2015 to June 2019. A total of 138 patients had multiple renal arteries with double arteries in 120 patients, triple arteries in 12 patients and four vessels in 6 patients. Vascular reconstruction of multiple vessels was done using the bench technique in 80 patients with double vessels and direct implantation in 33 patients. Lumen Discrepancy of 30/70 ratio based on preoperative imaging was seen in 45 patients in bench reconstruction group and 13 patients in separate implantation group. 40 patients with 30/70 lumen discrepancy underwent Pajama reconstruction. Postoperative outcomes (up to 1 year) were studied. The outcomes of recipients of a pajama bench reconstruction in double vessels with 30/70 luminal discrepancy were compared with that undergoing end to side reconstruction and direct implantation.
Results: Patients of 30/70 luminal discrepancy were divided into three groups based on technique of reconstruction/ implantation: Group A (n= 40), B (n=5), and C (n= 13) with Pajama reconstruction, end to side reconstruction and separate implantation respectively. Mean vessel diameter ratios were 1.95±0.55:6.25±1.25 mm, 1.82±0.52:6.1±1.34 mm, and 1.87±0.59:6.3±1.5 mm in Group A, B and C respectively. There was a significant difference in Rewarm Ischemia time between the three groups (45.26±12.6min versus 46.78±10.65minutes, versus 56.38±10.12min, p= <0.0001). No significant difference was found between the three groups for Creatinine levels at day 7 and at 3 months. No significant difference was seen in Clavien Dindo grade complications between three groups.
Conclusion: Double donor renal arteries are preferably reconstructed on bench to minimize prolonged rewarm ischemia time. Pajama reconstruction is feasible with equivalent short-term graft function, complications and reduced technicality in cases with significant luminal discrepancy of 30:70 between the two arteries.
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