Vascular constraints in laparoscopic renal allograft: Comparative analysis of multiple and single renal arteries in 976 laparoscopic donor nephrectomies

Background: Since the initial description of laparoscopic donor nephrectomy (LDN) in 1995, the field of renal transplantation has continued to evolve. Although the identification of donor kidneys with multiple renal arteries (MRA) was considered a contraindication to LDN, improvement in the surgical technique to surmount the technical challenges of LDN with MRA have been established as the skill and laparoscopic experience of transplant surgeons evolves with time. Consensus regarding LDN with MRA and recipient outcomes is not uniformly documented amongst the transplant community. Methods: A retrospective analysis of 976 patients who underwent LDN at our institution from January 1999 to August 2009 was performed. Patients were grouped based on the number of arteries and the data were compared with respect to patient demographics, operative characteristics, postoperative course and complications. Results: The two donor groups had comparable outcomes except for operative time, which was significantly prolonged in patients with MRA kidneys when compared to a single renal artery (SRA) kidney (P < 0.01). 1-, 3-year and estimated overall graft survival for the MRA recipient kidneys was significantly inferior when compared to SRA recipient kidneys. Conclusions: Our decade long experience with LDN demonstrates that operative times for MRA kidneys are longer than for SRA kidneys, however complication rates are similar. Laparoscopic donor nephrectomy with MRA is a safe and effective procedure for living kidney donation; however, the recipient graft outcomes with MRA kidneys warrant appropriate preoperative counseling of recipients.