AORTIC RECONSTRUCTION IN KIDNEY-TRANSPLANT RECIPIENTS

Penal transplantation has increased the longevity of patients with ure mia. An increasing number undergo aortic reconstruction, which exposes the transplanted kidney to ischemic injury. To evaluate the risk for renal failure, loss of the transplant, and methods of renal protection , we reviewed our experience. Clinical data were reviewed for 10 conse cutive patients (7 men, 3 women; mean age 52.7 years [range 32 to 75 y ears]) with a transplanted kidney who underwent aortic reconstruction between 1977 and 1994 at our institution. Mean interval between renal transplantation and aortic reconstruction was 5.9 years (range 1 month to 12.7 years). Seven patients required emergency repair because of d issection (2 patients), aneurysm rupture (4 patients), or symptomatic aneurysm (1 patient); three underwent elective repair. Reasons for rec onstruction included aortic dissection (2 patients), aneurysm of the d escending thoracic (2 patients), thoracoabdominal (1 patient), or abdo minal aorta (3 patients), and aortoiliac occlusive disease (2 patients ). Patients with thoracic or thoracoabdominal reconstructions underwen t repair with atriofemoral, aortofemoral, or femorofemoral shunt place ment or bypass. Of the five abdominal aortic reconstructions, the kidn ey was protected with aortofemoral shunt placement in one patient and cold renal perfusion in three. In two of them, topical cooling of the kidney also was used. One patient with acute aortic dissection died at 39 days as a result of respiratory failure. Loss of the recently tran splanted kidney was caused by acute rejection. One patient had a trans ient increase in serum creatinine concentration. Eight had no worsenin g of renal function, and none of the nine survivors lost the transplan ted kidney. We conclude that aortic reconstruction can be safely perfo rmed in kidney transplant recipients, Patients in whom thoracic or tho racoabdominal aortic reconstruction was required were protected with a n atriofemoral or aortofemoral bypass or shunt. Patients undergoing ab dominal aortic reconstruction did well when cold renal perfusion with or without local cooling of the transplant was used for renal protecti on, Transplanted kidneys appeared to tolerate ischemic injury similarl y to native kidneys.