ArticleClinical transplantation and research2025
Comparative outcomes of separate versus pantaloon anastomosis in two renal artery living donor kidney transplantation: a retrospective cohort study.
Article in Clinical transplantation and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The optimal surgical approach for managing multiple renal arteries in living donor kidney transplantation remains unclear. This study compared outcomes between separate anastomoses (SA) and pantaloon anastomosis (PA). Methods: A retrospective cohort study was conducted from November 2018 to August 2024. In total, 117 patients were included (SA, 67; PA, 50). The primary outcome was arterial complications. Secondary outcomes included renal function, graft and patient survival at 1 year, and intraoperative variables. Statistical analyses utilized the t-test, the Mann-Whitney U-test, and Kaplan-Meier survival curves. Results: The mean warm ischemia time was similar between groups (105.48±35.64 vs. 103.92±33.51 min; P=0.811). Cold ischemia time was also comparable (75.90±14.36 vs. 80.68±17.85 min; P=0.111). However, anastomosis time was significantly longer in the SA group (39.00 [35.00-43.00] min) compared with the PA group (34.00 [28.50-39.50] min; P<0.001). The immediate postoperative creatinine reduction was slightly greater in the SA group (46.83%±20.68% vs. 39.78%±19.04%; P=0.090). Vascular complications requiring re-exploration were infrequent in both groups (1.5% vs. 2.0%). At 1 year posttransplant, creatinine levels were comparable between the SA (1.20 [0.95-1.45] mg/dL) and PA (1.20 [1.05-1.35] mg/dL) groups (P=0.337). Regression analysis confirmed that postoperative creatinine levels were independently associated with SA (P=0.006). Graft survival was similarly high (97% vs. 98%), as was patient survival (100% vs. 96%). Conclusions: Both anastomosis techniques are safe and effective for transplanting kidneys with anatomical anomalies. SA offers surgical efficiency and provides superior early renal recovery.
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