Objective: To review our experience with cadaveric kidney transplantation with ex situ reconstruction of damaged renal artery.
Methods: To obtain a minimum follow-up of 5 years, 20 cases treated from January 1989 to December 1994 were retrospectively reviewed. The control group comprised 73 patients that had received an "ideal" graft during the same period. Both groups were similar for all the variables that could influence graft outcome.
Results: Both groups showed similar results for incidence of NTA, rejection episodes, creatinine values, surgical complications or reoperations. However, a strong trend (25% of the cases) to develop renal artery stenosis was found (p = 0.052). These latter cases were diagnosed by the onset of arterial hypertension that was difficult to control and were treated conservatively by percutaneous angioplasty with good functional results in 100% of the cases, although 80% required more than one session. This complication, however, did not lead to graft failure.
Conclusions: Renal grafts with arteries damaged during procurement or as a result of pathological changes, such as arteriorclerosis or aneurysm, are useful after bench reconstruction before transplantation. However, the greater trend to develop symptomatic arterial stenosis that has been observed makes it convenient to look for this complication routinely during follow-up. If diagnosed and treated early, it does not influence the graft outcome. The therapeutic approach is first by percutaneous transluminal angioplasty and if it fails, then by open surgery.