Preoperative planning and surgical technique for multiple vessel renal transplant based on MSCT angiography

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Objective: to evaluate the diagnostic value of preoperative multislice computed tomography (MSCT) angiography in planning arterial reconstruction strategies for multi-vessel renal transplants, and to assess the relationship between the selected surgical technique, intraoperative parameters, and clinical outcomes of kidney transplantation. Materials and methods . A single-center observational study was conducted, including 120 kidney transplants from deceased donors. Of these, 78 grafts (65.0%) had multivessel arterial anatomy, while 42 grafts (35.0%) with single-artery and single-vein anatomy served as the control group. Preoperative planning was based on donor MSCT angiography, with assessment of the number of renal arteries, interostial distance, vessel diameter, presence of an inferior polar artery (IPA), and the feasibility of creating a single arterial ostium. In the multi-vessel group, arterial reconstruction techniques included Carrel patch reconstruction, pantaloon (fish-mouth) reconstruction, and separate arterial anastomoses. Evaluated parameters included the duration of extracorporeal arterial reconstruction, warm and cold ischemia times, incidence of delayed renal graft function (DGF), vascular and urological complications, and estimated glomerular filtration rate (eGFR) at 12 months post-transplant. The reproducibility of morphometric measurements derived from angiographic data was assessed using the intraclass correlation coefficient (ICC) and the Bland–Altman analysis. Results. In the multi-vessel group, arterial reconstruction was performed using the pantaloon (fish-mouth) technique in 28 cases, Carrel patch reconstruction in 26 cases, and separate arterial anastomoses in 24 cases. The choice of reconstruction strategy was determined by arterial orifice configuration, the ratio of vessel diameters, the presence of a common aortic patch, and the presence of a clinically significant IPA. Warm ischemia time was significantly longer in the multi-vessel graft group compared with the control group and also differed among reconstruction techniques. The shortest warm ischemia time was observed with the pantaloon reconstruction, whereas the longest was recorded in cases with separate anastomoses. The incidence of DGF, as well as vascular and urological complications, did not differ significantly between the reconstruction options. In the subgroup with a clinically significant IPA, preservation of this vessel was associated with a lower rate of urological complications; however, this difference did not reach statistical significance. The reproducibility of morphometric measurements based on angiographic data was high, with an ICC of 0.92. Bland–Altman analysis demonstrated a mean bias of –0.14 mm, with limits of agreement ranging from –2.36 to 2.09 mm. Conclusion. Preoperative MSCT angiography enables objective assessment of the vascular anatomy of a renal graft and supports the use of standardized morphometric criteria in selecting an appropriate arterial reconstruction strategy. Differences between reconstruction techniques are primarily reflected in warm ischemia time and duration of arterial reconstruction. However, when an appropriate technique is selected and fundamental principles of vascular surgery are adhered to, these variations do not adversely affect early clinical outcomes.