Document Type : Case Reports
Authors
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 transplant surgery is the preferred treatment for patients with end-stage kidney disease (ESKD), offering superior survival and quality of life compared to dialysis. However, anatomical variations, such as multiple kidney arteries (MKA), increase surgical complexity and may increase the risk of vascular complications. This case series reports six live-donor kidney transplantations performed between October 2021 and February 2023 at a tertiary care center, in which donor grafts exhibited dual, triple, or early arterial branching. Surgical strategies were tailored to the arterial anatomy. pantaloon reconstruction was performed for closely spaced arteries, separate end-to-side anastomoses were performed for widely spaced vessels, and the inferior epigastric artery was used for distant polar branches when necessary. All grafts were implanted onto the external iliac vessels, and ureteroneocystostomy was completed using the modified Lich-Gregoir technique without stenting. All recipients (five males and one female; mean age 35.5 years) demonstrated immediate graft function with satisfactory urine output and progressive decline in serum creatinine levels. The mean serum creatinine at discharge was 1.16 mg/dL (range 0.72–1.6 mg/dL). No significant postoperative complications, including vascular thrombosis, urinary leak, delayed graft function, or acute rejection, were observed. Patients were discharged between postoperative days 5 and 8 (mean 6.5 days). These findings demonstrate that with meticulous bench reconstruction and tailored vascular techniques, kidneys with multiple arterial anatomy can be safely transplanted with excellent short-term outcomes. The inclusion of such grafts can effectively expand the donor pool without compromising recipient safety or graft function.
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