Background: In kidney transplantation, up to 29% of donor kidneys are reported to have more than one renal artery¹. In deceased donor transplantation, the anastomosis of the accessory arteries is facilitated by the presence of the Carrell’s Patch. In living donor transplantation these arteries are anastomosed individually or after reconstruction. Multiple arterial anastomosis increases the anastomosis time and the risk of thrombosis and stenosis.  Presence of an accessory lower renal artery may have significant contribution to ureteric blood supply². We report the impact of utilizing recipient inferior epigastric artery (IEA) for anastomosis to the lower polar renal artery on kidney perfusion and ureteric complications. 
Method: We analysed the outcome of kidney transplants performed in our centre in from 01 July 2022 to 21 November 2023. The incidence of primary graft function, kidney perfusion, vascular and ureteric complications were analysed. The lower polar artery to IEA anastomosis was performed using interrupted 7/0 prolene after reperfusion of the kidney with main renal artery. The patients with IEA anastomosis were maintained on heparin infusion 150 unit/hr for 5 days. A doppler ultrasound scan was performed in all patients on day 1 following our centre protocol.
Results: One hundred twenty-five (65 living and 60 deceased donor) kidney transplants were performed in our centre during the study period. Of the 65 living donor transplants, 15 kidneys had multiple renal arteries including nine lower polar arteries. Seven of the lower polar arteries were anastomosed to recipient IEA and two to the external iliac artery. All kidneys had primary function. Day 1 doppler revealed uniform perfusion of the kidney including the lower pole supplied by the accessory artery. There was 3 reported case of ureteric leak non IEA group and no early ureteric stenosis in either the study or the control group.
Conclusion: Revascularisation of the accessory lower polar renal artery utilizing the recipient inferior epigastric artery is a viable and safe option in living donor kidney transplant.

References:

1- Gulas E, Wysiadecki G, Cecot T, et al. Accessory (multiple) renal arteries – Differences in frequency according to population, visualizing techniques and stage of morphological development. Vascular. 2016;24(5):531-537. doi:10.1177/1708538116631223

2- Cherchi V, Baccarani U, Ventin M, Pravisani R, Puggioni A, Zanini V, Lorenzin D, Vetrugno L, Risaliti A, Terrosu G, Adani GL. Current practice with grafts with multiple renal arteries in kidney transplantation: role of the methylene blue in the lower pole. Acta Biomed. 2022 Mar 14;93(1):e2022006. doi: 10.23750/abm.v93i1.12081. PMID: 35315402; PMCID: PMC8972855.