Background: The presence of multiple renal vessels (MRVs) in living and deceased organ donors has been a topic of interest. Historically, transplanting kidneys with MRVs was considered risky due to higher complication rates. However, advancements in vascular reconstruction and anastomosis techniques have improved graft outcomes.
Methods: We retrospectively evaluated 3534 renal transplants performed between November 1975 and March 2024. These included both living and deceased donors. These patients consisted of single renal vessel (SRV) grafts (2516 living donors and 664 deceased donors) and MRV grafts (278 living donors and 76 deceased donors). Anastomoses were performed using internal iliac artery, external iliac artery, inferior epigastric artery. The SRV group (n = 3180) consisted of grafts with single renal vessels (SRVs). The MRV group (n = 354) were composed of 181 multiple renal artery grafts and 173 multiple renal vein grafts. In multiple renal artery grafts, 166 had 2, 13 had 3, 2 had 4, and 1 had 5 arteries. In multiple renal vein grafts, 145 had 2, 28 had 3 veins. 3 In this study we retrospectively MRV group in terms of evaluated parameters evaluated included cold ischemia time, anastomosis time, perioperative complications, creatinine clearance, acute tubular necrosis (ATN), serum creatinine levels, graft rejection episodes, and graft and patient survival rates.
Results: No significant differences were observed between the SRV and MRV groups in terms of creatinine clearance, cold ischemia time, anastomosis time, ATN, and serum creatinine levels at 1, 2, and 5 years posttransplant. Graft survival rates at 1 and 5 years were comparable between the groups (SRV: 93% and 79.2%, MRV: 92.9% and 79.6%). Patient survival rates were also similar (SRV: 95.4% and 93%, MRV: 97.1% and 87%).
Conclusion: Transplantation of grafts with multiple vessels can be performed without causing complications due to advanced anastomosis techniques and increased experience. MRVs can maintain normal functions as well as SRVs.