AORTOILIAC RECONSTRUCTION AND KIDNEY-TRANSPLANTATION - A MULTICENTER STUDY

The occurrence of aortoiliac lesions with renal transplantation is an increasingly common combination that causes problems regarding operati ve strategy and indications for aortoiliac reconstruction and renal tr ansplantation. To gain greater insight into these problems we undertoo k a retrospective multicenter study based on data from 24 kidney trans plantation centers in France. A total of 83 patients who underwent bot h aortoiliac reconstruction and kidney transplantation were enrolled. Patients were divided into two groups according to the order in which the two procedures were performed. Group I included 36 patients in who m aortoiliac reconstruction was performed before kidney transplantatio n-either during the same procedure (6 patients) or as separate procedu res (30 patients). Group II included 47 patients in whom aortoiliac re construction was performed after kidney transplantation. The mean age was 49.9 years. There were 43 abdominal aortic aneurysms (51.8%), 36 o cclusive aortoiliac lesions (43.4%), and 4 aortoiliac dissections (4.8 %). Prosthetic bypass grafting was performed in 72 cases (86.8%), tran sluminal angioplasty in 6 cases (7.2%), endarterectomy in 3 cases (3.6 %), and arterial autograft bypass in 1 case. Renal transplant protecti on was used during aortoiliac clamping in only 3 patients in group II (7.3%). One month after the second procedure (i.e., kidney transplanta tion in group I and aortoiliac reconstruction in group Il), creatinemi a was <200 mu mol/L in 27 patients (87.1%) in group I and in 37 patien ts (88.1%) in group II. The graft survival rate was 86.1% in group I a nd 89.3% in group II. The overall postoperative morbidity rate was 36. 1% (13 cases) in group I and 36.1% (17 cases) in group II. One year af ter the second procedure creatinemia was <200 mu mol/L in 29 patients (93.5%) in group I and 36 patients (93%) in group II. The graft surviv al rate was 86.1% in group I and 85.1% in group II. The outcome of kid ney transplantation is comparable regardless of whether the procedure is performed alone or in association with aortoiliac reconstruction. T his finding indicates that kidney transplantation should be performed in patients presenting indications for prior aortoiliac reconstruction . The outcome of aortoiliac reconstruction without graft protection in kidney transplant patients is comparable to the outcome of convention al aortoiliac reconstruction in patients with native kidneys.