Multiple renal arteries do not pose an impediment to the routine use of laparoscopic donor nephrectomy

Since the first description by Ratner and collegues in 1996, laparoscopic l ive-donor nephrectomy is gaining wide acceptance in an attempt to minimize the donor morbidity, length of hospital stay and length of time to return t o work. It is unknown whether multiple renal arteries pose additional probl ems with laparoscopic donor nephrectomy. In November 1998, our institution initiated laparoscopic donor nephrectomy program. In the ensuing 19 months, we performed 25 living donor renal transplants, 24 of them using laparosco pic donor nephrectomy. The left kidney was procured in all cases. Eight don or candidates (33%) had two or more renal arteries (two arteries in five pa tients and three patients). Results: In six cases (25%), findings at surger y differed from the CT angography results (in four cases. CT angiogram repo rted fewer arteries than were found at surgery and in two cases it reported more). We found no significant differences in both donor outcomes and reci pient, based on the presence or absence of multiple renal arteries. Among d onor outcomes, we found equivalent results for donor warm ischemia time tot al donor operating time, and donor length of stay. For recipient outcomes, we found no significant differences between groups for the incidence of acu te tubular necrosis (ATN), graft survival and most recent serum creatinine. In one case, we constructed two arteries into a single conduit on the back table prior to transplantation. However, in most cases with multiple arteri es, we implanted the arteries separately into the recipient external iliac artery. Based on this experience, we do not find the presence of multiple r enal arteries to be a barrier to the successful use of kidney grafts procur ed by laparoscopic donor nephrectomy.