Arterial Reconstruction in Kidney Transplantation

Since its introduction into clinical medicine in the 1950s kidney transplantation has become the preferred renal replacement therapy for patients suffering from end-stage renal disease (ESRD). The rising incident of ESRD is causally determined by an increased life expectancy. On the other hand the results of kidney transplantation have improved enormously due to advances in organ harvesting, organ preservation, surgical techniques and last but not least immunosuppressive regimens. Renal transplantation is more cost effective than haemodialysis and provides a better quality of life. This has resulted in a significant demand for organs that is not met by the current supply of deceased donors. Besides augmentation of the number of living kidney donation the lack of organs is partially compensated by extended donor criteria. Therefore the number of marginal organs with severe arteriosclerosis is rising. This makes great demands to the transplant surgeons. This article provides a review about techniques and pitfalls of arterial reconstruction during renal transplantation. It is based upon our experience in kidney transplantation and upon the published medical data. Despite rising technical difficulties caused by severe arteriosclerosis and the existence of multiple renal arteries kidney transplantation is a safe and highly efficient procedure.