Renal vessel extension with cryopreserved vascular grafts: overcoming surgical pitfalls in living donor kidney transplant

Abstract Background: LDKT is crucial to unburden waiting lists for renal transplant. Although the choice of the graft should be based on “leaving the better kidney to the donor”, right kidneys and kidneys with anomalous vascularization are often deferred because of concerns on complications and vascular reconstructions. To date, only few reports have examined renal vessel extension with cryopreserved vascular grafts in LDKT. The aim of this study is to investigate the effect of renal vessel extension on short-term outcomes and ischemia times in LDKT, especially in recipients of right kidney grafts or grafts with multiple vessels.Methods: From 2012 to 2020, recipients of LDKT with renal vessels extension through cryopreserved vascular grafts were compared with recipients of LDKT with no vascular lengthening. The primary endpoints were perioperative complications and DGF; secondary endpoints were warm and cold ischemia times.Results: Recipients of LDKT with (n=54) and without (n=91) vascular extension experienced similar hospital stays, surgical complications and DGF rates. For grafts with multiple vessels, renal vessel extension granted a faster implantation time (44±5 vs. 72±14 minutes), which resulted comparable to that of standard anatomy grafts. Right kidney grafts with vascular extension had a faster implantation time compared to right kidney grafts without vascular lengthening (43±5 vs. 58±9 minutes), and a comparable implantation time to left kidney grafts. Renal vascular extension resulted protective from prolonged implantation time.Conclusions: Renal vessel extension with cryopreserved vascular grafts allows a faster implantation time in right kidney grafts or grafts with anomalous vascularization, maintaining similar short-term surgical and functional outcomes.