Multiple renal veins in donor nephrectomy: Preoperative assessment of feasibility for safe and selective ligation
Akshay Kriplani1,2, Sanjoy Kumar Sureka2, Sanchit Rustagi2, Uday Pratap Singh2, M.S. Ansari2, Aneesh Srivastava2,3.
1Department of Urology and Renal Transplantation, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India; 2Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India; 3Consultant Urologist, Medanta Hospital Lucknow, Lucknow, Uttar Pradesh, India
The work is done at SGPGI, Lucknow, Uttar Pradesh, India.
Objective: To provide an objective preoperative assessment protocol by Computerised Tomography (CT) angiography by measuring the vein volume (π · r2 · h) instead of the vein diameter for accurate size and blood flow assessment in case of multiple renal veins during donor nephrectomy.
Material and Methods: In order to reduce rewarm ischaemia time smaller renal veins were safely ligated without compromising drainage due to their robust intrarenal anastomotic communications. The selection of vein for safe ligation is crucial to avoid congestion and high intrarenal pressures in the allograft venous system and was done by calculating the vein volume.
Result: Application of this formula in 343 donors with multiple veins (2003-2021) has led to uneventful intra- and postoperative course.
Conclusion: This method prevails over the existing subjective assessment techniques, thereby ensuring best possible perfusion and drainage of the allograft.
