DONOR AORTIC CUFF REDUCES THE RATE OF ANASTOMOTIC ARTERIAL-STENOSIS IN PEDIATRIC RENAL-TRANSPLANTATION

A total of 333 pediatric renal transplantations performed at our insti tution between January 1977 and July 1994 was retrospectively reviewed to provide guidelines for minimizing the incidence of transplant rena l artery stenosis. The patients who had renal artery stenosis were 3 m onths to 17.5 years old (median age 9.3 years) at the time of transpla ntation and the condition was diagnosed 2.2 months to 2.5 years (media n 4.2 months) after transplantation. Renal artery stenosis was diagnos ed in 19 transplants (19 of 333, 5.7%) as a result of severe hypertens ion or renal function deterioration. Stenosis occurred at the anastomo sis in 7 cases (37%) and distal to the anastomosis in 12 (63%). Transp lantations performed with. a donor aortic cuff resulted in a lower rat e of renal artery stenosis at the anastomosis (0 of 193, 0%) compared to those performed without a cuff (7 of 140, 5.0%, p = 0.0021). The ra te of renal artery stenosis distal to the anastomosis was not differen t regardless of whether a cuff was used (5 of 193 cases, 2.6%) or not (7 of 140, 5.0%, p = 0.37). End-to-end anastomoses to internal iliac a rteries, which were always performed without cuffs, had a particularly high rate of renal artery stenosis (3 of 10, 30%) compared to end-to- side anastomoses performed without cuffs (4 of 130, 3.1%, p = 0.0080). Bench surgery or multiple renal arteries did not adversely influence the rate of renal artery stenosis. With prompt diagnosis and treatment the actuarial graft survival of the transplants with renal artery ste nosis was similar to that of the transplants without :renal artery ste nosis (p >0.05).