Results of renal transplant with multiple renal arteries in Veracruz, Mexico
Resultados del trasplante renal con arterias renales múltiples en Veracruz, México
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Méndez-López, Luis F. Budar-Fernández, Sandro F. Ávila-Pardo, Felipe González-Velázquez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Gustavo" "apellidos" => "Martínez-Mier" "email" => array:1 [ 0 => "gmtzmier@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Oswaldo" "apellidos" => "López-Mendoza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Marco T." "apellidos" => "Méndez-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Luis F." "apellidos" => "Budar-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Sandro F." "apellidos" => "Ávila-Pardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Felipe" "apellidos" => "González-Velázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Trasplantes, IMSS UMAE 189 ARC, Hospital Regional de Alta Especialidad de Veracruz, Veracruz, México, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados del trasplante renal con arterias renales múltiples en Veracruz, México" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11588_108_39769_en_f17.jpg" "Alto" => 1155 "Ancho" => 1377 "Tamanyo" => 119122 ] ] "descripcion" => array:1 [ "en" => "Maximum survival of patients receiving kidney transplants arranged by the number of renal arteries" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor:</span></p><p class="elsevierStylePara">Many of the challenges presented by the surgical procedure of renal transplants are the result of anatomical variations, such as multiple renal arteries (MRA), which are present in 12%-30% of all transplanted kidneys.<span class="elsevierStyleSup">1-5</span> The surgical evaluation of live donors facilitates a determination of kidney anatomy in order to establish the safety of the nephrectomy, the most appropriate surgical technique to use, and the length of the blood vessels that will be used. Complex renal vascularisation continues to present a problem that can affect the prognosis of the transplant.<span class="elsevierStyleSup">2</span> The first studies involving this issue considered kidneys with MRA to be a contraindication due to the possible increase in vascular complications (stenosis of the renal artery or thrombosis and bleeding),<span class="elsevierStyleSup">4,5</span> although currently, the use of these kidneys is more widely accepted.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">We performed a retrospective analysis of 216 cases recorded over the course of 7 years; of these, 23 patients (10.6%) had MRA as compared to a control group (n=23) with single renal arteries (SRA). The mean patient age in the SRA group was 34±10.3 years (range: 18-52 years), whereas the mean age in the MRA group was 35±10.7 years (range: 17-51 years). The majority of patients were male in both groups (SRA: 82.6%, n=19; MRA: 82.6%; n=19). Mean body mass index (BMI) in the SRA group was 25.08±3.85kg/m<span class="elsevierStyleSup">2</span> (range: 19.74-36.94kg/m<span class="elsevierStyleSup">2</span>), and the mean BMI in the MRA group was 25.05±4.34kg/m<span class="elsevierStyleSup">2</span> (range: 19.07±36.7kg/m<span class="elsevierStyleSup">2</span>). The mean time on dialysis in the SRA group was 24±13.56 months (range: 3-78 months), and the mean time on dialysis in the MRA group was 26.2±19.21 months (range: 0-60 months), with no significant differences between groups. The majority of organ donors in the MRA group were male (n=15; 65.2%), whereas the majority of organ donors in the SRA group were female (n=17; 73.9%). The mean donor age in the MRA group was 35.7±9.5 years (range: 21-57 years), and the mean donor age in the SRA group was 36.1±10.1 years (range: 18-52 years). All nephrectomies form live donors were performed using open surgical procedures. Glomerulonephritis was the most commonly observed aetiology in the SRA group (54.5%; n=12), and aetiology of an unknown origin was most commonly observed among patients in the MRA group (54.5%; n=12).<span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara">In 2 non-heart beating donors with MRA, a Carrel patch was used on the external iliac artery of the recipient. In live donors, 20 kidneys (95.2%) had 2 renal arteries; 17 (73.9%) underwent a termino-lateral anastomosis between the two arteries. In 3 cases (13%), a double-barrel anastomosis was performed between the 2 renal arteries with a single anastomosis of the iliac artery in the recipient. One patient (4.3%) with MRA had 3 renal arteries, which were managed using 2 anastomoses with the recipient. In the SRA group, non-heart beating donated kidneys (n=2; 8.7%) were grafted using a Carrel patch, and kidneys from live donors (n=21; 91.3%) were joined to the external iliac artery using the traditional approach. We used induction therapy with basiliximab in 73% of SRA cases and in 56% of MRA cases. The most frequently used calcineurin inhibitor in both groups was cyclosporine (n=15; 65.2% in SRA vs n=14; 60.9% in MRA).</p><p class="elsevierStylePara">In the SRA group, the most frequently observed complication was surgical wound infection (8.7%; n=2) and one patient developed a ureterovesical stenosis. Urological complications (two urine leaks and one patient with reflux) were more common in the MRA group, as was delayed graft function (n=3; 13.6%). The total rate of complications in the SRA group was 13% (n=3) and the rate of complications in the MRA group was 30.4% (n=7). There were no vascular complications (thrombosis, bleeding, and stenosis) in either group. One case of lymphocele was produced in both groups.</p><p class="elsevierStylePara">The comparison of serum creatinine levels (mg/dl) was not statistically significant after 1 year (SRA: 1.5±0.5 vs MRA: 1.4±0.4), 3 years (SRA: 1.45±0.21 vs MRA: 1.27±0.28), or 5 years (SRA: 1.46±0.39 vs MRA: 1.3±0.25), and the same occurred for creatinine clearance rate as calculated using the Cockcroft-Gault formula (ml/min) after 1 year (SRA: 68±18 vs MRA: 70±16), after 3 years (SRA: 74±14 vs MRA: 74±9) or after 5 years (SRA: 65±17 vs MRA: 65±13). In the SRA group, 7 patients (30.4%) were no longer hypertensive after transplantation, and in the MRA group, 10 patients (43.4%) were no longer hypertensive. As a measure against post-transplantation hypertension, 7 patients in the SRA group (31.8%) and 4 patients in the MRA group (19%) were prescribed 2 different medications (<span class="elsevierStyleItalic">P</span>-value: non-significant). There were no significant differences in terms of patient survival between the two groups (Figure 1). Figure 2 compares graft survival based on the number of renal arteries, with 60 months of follow-up for both groups.</p><p class="elsevierStylePara">Our results show that post-transplant hypertension and complications associated with kidney transplantation do not differ between patients who receive kidneys from MRA donors and those who receive kidneys from SRA donors, with no effects on graft or patient survival. The existence of MRA and the use of bench procedure surgical techniques are no longer contraindications, especially when kidneys are provided by living donors.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors state that they have no potential conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><a href="grande/11588_108_39769_en_f17.jpg" class="elsevierStyleCrossRefs"><img src="11588_108_39769_en_f17.jpg" alt="Maximum survival of patients receiving kidney transplants arranged by the number of renal arteries"></img></a></p><p class="elsevierStylePara">Figure 1. Maximum survival of patients receiving kidney transplants arranged by the number of renal arteries</p><p class="elsevierStylePara"><a href="grande/11588_108_39770_en_f27.jpg" class="elsevierStyleCrossRefs"><img src="11588_108_39770_en_f27.jpg" alt="Survival of kidney grafts arranged by number of renal arteries"></img></a></p><p class="elsevierStylePara">Figure 2. Survival of kidney grafts arranged by number of renal arteries</p>" "pdfFichero" => "P1-E544-S3785-A11588-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11588_108_39769_en_f17.jpg" "Alto" => 1155 "Ancho" => 1377 "Tamanyo" => 119122 ] ] "descripcion" => array:1 [ "en" => "Maximum survival of patients receiving kidney transplants arranged by the number of renal arteries" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11588_108_39770_en_f27.jpg" "Alto" => 1189 "Ancho" => 1377 "Tamanyo" => 120095 ] ] "descripcion" => array:1 [ "en" => "Survival of kidney grafts arranged by number of renal arteries" ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000006/v0_201502091602/X201325141200214X/v0_201502091603/en/main.assets" "Apartado" => array:4 [ "identificador" => "35438" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000006/v0_201502091602/X201325141200214X/v0_201502091603/en/P1-E544-S3785-A11588-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200214X?idApp=UINPBA000064" ]
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| 2020 January | 48 | 29 | 77 |
| 2019 December | 43 | 25 | 68 |
| 2019 November | 51 | 42 | 93 |
| 2019 October | 35 | 26 | 61 |
| 2019 September | 32 | 30 | 62 |
| 2019 August | 25 | 14 | 39 |
| 2019 July | 26 | 22 | 48 |
| 2019 June | 44 | 11 | 55 |
| 2019 May | 26 | 11 | 37 |
| 2019 April | 54 | 23 | 77 |
| 2019 March | 43 | 30 | 73 |
| 2019 February | 34 | 46 | 80 |
| 2019 January | 36 | 24 | 60 |
| 2018 December | 72 | 35 | 107 |
| 2018 November | 61 | 16 | 77 |
| 2018 October | 51 | 21 | 72 |
| 2018 September | 49 | 18 | 67 |
| 2018 August | 50 | 19 | 69 |
| 2018 July | 43 | 11 | 54 |
| 2018 June | 45 | 23 | 68 |
| 2018 May | 37 | 16 | 53 |
| 2018 April | 41 | 12 | 53 |
| 2018 March | 47 | 21 | 68 |
| 2018 February | 29 | 20 | 49 |
| 2018 January | 29 | 16 | 45 |
| 2017 December | 48 | 12 | 60 |
| 2017 November | 36 | 8 | 44 |
| 2017 October | 33 | 12 | 45 |
| 2017 September | 38 | 18 | 56 |
| 2017 August | 38 | 12 | 50 |
| 2017 July | 43 | 18 | 61 |
| 2017 June | 31 | 14 | 45 |
| 2017 May | 35 | 15 | 50 |
| 2017 April | 44 | 41 | 85 |
| 2017 March | 21 | 17 | 38 |
| 2017 February | 26 | 15 | 41 |
| 2017 January | 27 | 15 | 42 |
| 2016 December | 45 | 10 | 55 |
| 2016 November | 40 | 11 | 51 |
| 2016 October | 66 | 11 | 77 |
| 2016 September | 87 | 14 | 101 |
| 2016 August | 193 | 17 | 210 |
| 2016 July | 162 | 12 | 174 |
| 2016 June | 128 | 0 | 128 |
| 2016 May | 127 | 0 | 127 |
| 2016 April | 132 | 0 | 132 |
| 2016 March | 84 | 0 | 84 |
| 2016 February | 118 | 0 | 118 |
| 2016 January | 117 | 0 | 117 |
| 2015 December | 126 | 0 | 126 |
| 2015 November | 105 | 0 | 105 |
| 2015 October | 96 | 0 | 96 |
| 2015 September | 68 | 0 | 68 |
| 2015 August | 75 | 0 | 75 |
| 2015 July | 75 | 0 | 75 |
| 2015 June | 50 | 0 | 50 |
| 2015 May | 55 | 0 | 55 |
| 2015 April | 11 | 0 | 11 |
Show all
