Multi-vessel renal transplantation

Multiple renal artery kidneys are now considered acceptable for transplantation in order to overcome the shortage of available organs. However, these procedures are disliked by kidney transplant surgeons due to the belief that they will cause more complications when compared to transplants of kidneys with single renal arteries. The aim of this study was to analyse the literature to determine if the rate of vascular and urological complications was significantly different in recipients of kidneys with multiple renal arteries compared to recipients of kidneys with single renal arteries. Kidney function, patient survival and graft failure rates at 1-year post-transplantation were compared. Literature searches of the databases EMBASE, MEDLINE and PubMed were performed in June 2020 and identified 607 articles, of which 18 were considered eligible to be included in this review. Of the 18 articles analysed, the prevalence of multiple renal artery transplants ranged from 5.4% to 31.4%. All 18 studies recorded kidney function and graft failure at 1-year post-transplantation, with 15 studies concluding that there was no significant difference between comparative groups for kidney function, and 14 studies concluding that there was no significant difference for graft failure. Of the 10 studies that recorded patient survival at 1- year post-transplantation, eight studies reported no significant difference between comparative groups. Vascular complications occurred at a rate of 0%– 9.2% in single renal artery recipients compared to 0%– 20% in multiple renal artery recipients. However, this difference was only statistically significant in two out of 15 studies that reported statistical values; with the remaining three studies not reporting statis-tical values. Urological complications occurred at a rate of 1.26%– 16% in recipients of single renal artery kidneys compared to 0%– 12% in recipients of multiple renal artery kidneys. Only one study concluded that there was a significant difference between the two comparative groups for the rate of urological complications. Consequently, transplantation of kidneys with multiple renal arteries was found to be safe, as in general, no significant difference in transplant outcomes was found by comparative reports. Urosurgeons should, therefore, consider accepting donations from multiple renal artery donors.