International Journal of Scientific Research in Dental and Medical Sciences

International Journal of Scientific Research in Dental and Medical Sciences

Tailored Vascular Reconstruction Strategies for Multiple Renal Arteries in Living Donor Kidney Transplantation: A Case Series

Document Type : Case Reports

Authors
Karamveer Singh 1
Vikas Chandel 2
Shahbaj Ahmad 2
Shikhar Agarwal 3
Rajeev Sarpal 3
Nidhi Kumar 4
1 Department of General Surgery, Division of Organ Transplant, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of General Medicine, Division of Nephrology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
3 Department of Urology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
4 Department of Anesthesia and Pain Medicine, Division of Organ Transplant Anesthesia, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
10.30485/ijsrdms.2026.565366.1690
Abstract
Kidney transplantation remains the treatment of choice for patients with end-stage kidney disease (ESKD); however, grafts with multiple renal arteries (MRA) continue to pose technical challenges because of their complex vascular anatomy. This study aimed to describe our institutional experience with individualized vascular reconstruction strategies for living-donor kidneys with complex arterial anatomy and to evaluate their early clinical outcomes. We retrospectively reviewed six consecutive living-donor kidney transplantations performed between October 2021 and February 2023 involving grafts with dual, triple, or early arterial branching. The vascular reconstruction technique was selected based on the anatomical configuration. It included pantaloon reconstruction for closely spaced arteries, separate end-to-side anastomoses for widely spaced vessels, and an inferior epigastric artery anastomosis for distant polar arteries before implantation into the external iliac vessels. All six recipients (five males and one female; mean age, 35.5 years) demonstrated immediate graft perfusion and prompt urine output following transplantation, with progressive improvement in renal function and a mean discharge serum creatinine of 1.16 mg/dL (range, 0.72–1.60 mg/dL). No major postoperative complications, including vascular thrombosis, urinary leakage, delayed graft function, or acute rejection, were observed, and all patients were discharged between postoperative days 5 and 8 with stable graft function. These findings demonstrate that meticulous preoperative planning and individualized vascular reconstruction based on arterial anatomy enable the safe transplantation of kidneys with multiple renal arteries and provide excellent short-term outcomes, supporting the broader utilization of these anatomically complex grafts to expand the living-donor pool.
Keywords
Anatomic Variation
Kidney Transplantation
Living Donors
Subjects
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International Journal of Scientific Research in Dental and Medical Sciences
Volume 7, Issue 4
Autumn 2025
Pages 197-202

  • Receive Date 10 October 2025
  • Revise Date 13 November 2025
  • Accept Date 24 November 2025
  • Publish Date 01 December 2025