ArticleCureus2025
Comparison of Double Versus Single Renal Artery Anastomosis in Kidney Transplantation and Their Impact on Graft Survival, Surgical Outcomes, and Postoperative Complications.
Article in Cureus, 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
backgroundKidney transplantation remains the preferred treatment for end-stage renal disease (ESRD), offering better survival and quality of life than dialysis. Anatomical variations such as double renal arteries, however, may increase the technical complexity of vascular anastomosis. Data comparing outcomes between single and double renal artery grafts are limited in our region. The purpose of this study was to compare the graft function, surgical outcomes, and postoperative complications of kidney transplant recipients who had a single renal artery anastomosis with those who had a double renal artery anastomosis.
methodsThis prospective comparative observational study was conducted at the Institute of Kidney Diseases (IKD), Peshawar, from April 2023 to April 2025. A total of 80 adult renal transplant recipients were included: 50 with single renal artery grafts and 30 with double renal artery grafts. Donor and recipient demographics, ischemia times, perioperative complications, graft function (serum creatinine, estimated glomerular filtration rate (eGFR), urine output, and delayed graft function (DGF)), and one-year graft survival were analyzed. Statistical analysis was performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA), with significance set at p < 0.05.
resultsBaseline donor and recipient characteristics were comparable between groups. Warm ischemia time was significantly longer in the double artery group (38.1 ± 9.2 vs. 32.8 ± 8.5 minutes, p = 0.01), while cold ischemia time showed a non-significant trend toward prolongation (47.5 ± 12.8 vs. 42.3 ± 11.2 minutes, p = 0.07). Graft function outcomes were similar, with no significant differences in serum creatinine at 12 months (1.48 ± 0.39 vs. 1.36 ± 0.35 mg/dL, p = 0.18), eGFR (56.1 ± 10.9 vs. 58.4 ± 11.6 mL/min/1.73 m², p = 0.39), urine output (3.0 ± 0.8 vs. 3.2 ± 0.9 L, p = 0.42), or DGF (16.7% vs. 12%, p = 0.58). Postoperative complications, including vascular thrombosis, urological issues, re-exploration for bleeding, and acute rejection, showed no significant differences. One-year graft survival was excellent in both groups.
conclusionDouble renal artery anastomosis in kidney transplantation is safe and effective, with comparable graft function, complication rates, and survival to single renal artery anastomosis. Despite a modestly longer warm ischemia time, outcomes remained equivalent, supporting the use of kidneys with multiple renal arteries to expand the donor pool in resource-limited settings.
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