Evaluation of the renal transplant outcomes did not have shown a significant difference in the postoperative complication rate, rate of delayed graft function (DGF), serum creatinine levels at 1, 6, or 12 months postoperatively, and 1-year graft survival among recipients of allografts with and without renal vascular variations. However, operation time and the length of hospital stay were significantly longer among recipients of allografts with variant vasculature.
In the present study 34 (28.3%) renal transplantations were performed by using renal allografts with variant vasculature. All the renal allografts (100%) that have been used for the transplantations carried out in the center were left kidneys. The practice of selecting left-sided grafts is not uncommon and has been reported in several studies (12–14). Furthermore, previous studies have commented on an increased risk of early graft failure with transplanting right-sided renal allografts (15). In contrast, some centers have used a large number of right-sided renal allografts and reported no significant difference in graft function (16). The preference of left- sided renal allografts is often due to the longer left renal vein, which makes vascular anastomosis technically easier and also been shown to decrease operating time (16).
Post-operative serum creatinine level is an important measure of the outcome of renal transplantation. The present study has shown the post-operative serum creatinine level values recorded at postoperative week 1, first month, sixth month, and one year were not significantly differed between recipients of allografts with and without variant renal vasculature. This finding supports the reports of Ashraf et al. and Basaran et al. who also declared no significant difference on the serum creatinine values at one, two or five years between recipients of allografts with and without renal vascular variations (13, 17).
A comparative higher rate of postoperative complication rate was registered (14.7%) among recipients of allografts with variant renal vasculature, however the difference was statistically insignificant compared to recipients of allografts without variant renal vasculature (6.9%). Similar to this finding, a study by Hsu et al. also did not see a difference in intra- and postoperative complication rates in a series comparing 277 allograft with normal vascular anatomy and 76 variant vasculature (18). However, Carter et al found a small increase in ureteral complications among recipients with vascular variant graft (19).
Diuresis of the transplanted kidney on the operation table is another important parameter of successful renal transplantation. In the current study, 95% of the transplanted allografts could have produced urine immediately after reperfusion. There was no significant difference noted between the groups on the rate of diuresis after reperfusion. In line with this finding, Lafrancha et al. reported no significant differences in the occurrence of diuresis of the transplanted kidney on the operation table (p = 0.735). Moreover, a study by Asuri krishina et al. showed the mean urine output postoperative day 1 and postoperative day 7 were not significantly different between recipients of complex vascular allografts and simple vascular allografts (20). Similarly, Kok et al, reported urine production within one hour of reperfusion was 91% for single artery allograft recipients and 92% for multiple artery allograft recipients (p = 0.639) (21).
In the present study, operation time and the length of hospital stay were significantly longer among recipients of allografts with variant vasculature. In contrast to this finding, several other studies have reported that operation time and length of hospital stay were shorter and not significantly different among recipients of allografts with and without vascular variation (12, 20, 22). The longer operation time reported in this study is may be due to the open approach of the donor nephrectomy procedure employed in the transplantation center as this procedure is performed simultaneously with the transplantation surgery. Open donor nephrectomy takes longer operation time as compared to laparoscopic nephrectomy (14). Despite a statistically significant difference noted in the operation time and length of hospital stay, the clinical impact of these parameters is limited (12). Estimated blood loss, 30 day readmission and reoperation rates were not significantly different with the renal vascular variations of the renal allograft, and this finding is supported by many other authors (20–22).
The 1-year graft survival rate was nearly unaffected by the renal vascular anatomy in this study, and was greater than 90% in both groups. The grafts without vascular variations had better graft survival at different points of measurement, but the difference was not statistically significant (p = 0.378). This finding is consistent with graft survival rates reported in various previous studies. The study by Hsu et al. analyzed 76 recipients of variant vascular grafts and reported a 1-year graft survival rate of 93.4% (18). Similarly, Desai et al. retrospectively reviewed 27 recipients of renal allograft with multiple renal artery and reported the overall graft survival rate of 92.6% (23).