The aim of this study was to evaluate frequency and management of vascular complications in renal allograft.
Patients and methods
We performed retrospective analysis of patients who underwent renal allograft from 2001 to 2006 at our university hospital center. In order to access peri- and postoperative vascular complications, data were also obtained from donors and receivers, as well as organ procurement and renal transplant procedure.
One hundred and seventy-nine files were analyzed with a median follow-up of 40 months, mean age of donors was 40.4±11.2 years and 46.01±10.6 years for receivers. Seventy-two allograft patients had at least one vascular complication, with 32 cases of renal arterial stenosis, 28 cases of hematoma with surgical exploration required in seven cases, four cases of arterial thrombosis, two cases of venous thrombosis and one arterial dissection. Our series underlines that tobacco abuse in donors is a risk factor for vascular complication (p =0.043), as well as glomerular nephropathy (p =0.0185), coagulopathy (p =0.0165) and hemodialysis (p =0.02) are risk factors for receivers. Multiple arteries in renal allograft (p =0.03) and calcification on aortic patch (p =0.0274) would present a greater risk of postoperative complications. Our results demonstrate that the following parameters i.e., postoperative transfusion (p =0.011), heparin therapy (p =0.0085), immunosuppression (p =0.0478), and peri-operative aminovasopressive drugs (p =0.086) could also be implicated in vascular complication occurrence.
A careful selection of donors remains a major factor for renal allograft quality, however arterial evaluation and coagulopathy detection in receivers must also be performed prior to transplantation procedure. A multidisciplinary approach (nephrologist, urologist, anesthesist) will optimize vascular ischemia delay and also reduce early and late vascular complications, which could have possible consequences on renal allograft and patient survival.