KIDNEY-TRANSPLANTATION - THE USE OF LIVING DONORS WITH RENAL-ARTERY LESIONS

Purpose: A shortage of organs for transplantation has forced surgeons to optimize the use of marginal organs, such as kidneys with arterial disease. We present a retrospective study of the outcome of donors wit h renal artery disease and recipients of kidneys from living related a nd unrelated donors. Materials and Methods: Kidneys with vascular abno rmalities from healthy living donors were grafted into 11 recipients. These kidney transplants comprised 1.8% of those performed at our inst itution. The vascular abnormalities were aneurysms in 3 cases, atheros clerotic lesions in 4 and fibromuscular dysplasia in 4. After nephrect omy all abnormalities were corrected under hypothermic conditions duri ng bench surgery except in 3 cases of ostial atherosclerotic plaque, w hich was left in the donors. The renal artery was anastomosed to the e xternal iliac artery in 5 cases and to the internal iliac artery in 6. The ureter was reimplanted using an extravesical technique. Results: All patients had immediate diuresis and no delayed post-transplant gra ft dysfunction was observed. One patient died of an unrelated cause an d 3 had post-transplant graft function loss due to acute vasculopathy in 1, post-diarrhea with acute arterial thrombosis in 1 and recurrence of the hemolytic-uremic syndrome in 1. All remaining patients are wel l with median serum creatinine of 1.4 mg./dl. (normal 0.4 to 1.4). All donors are well and normotensive with normal renal function. Conclusi ons: The use of kidneys with arterial disease from living donors with unilateral disease is safe. Complete informed consent regarding the ri sks and benefits by donor and recipient is mandatory.