Optimal techniques for managing lower polar arteries in kidney transplantation.

Objective: Kidney transplantation is the gold standard treatment for end-stage renal disease; however, variations in renal arterial anatomy, particularly the presence of additional lower polar arteries (LPAs), pose surgical challenges. The optimal management of the LPAs remains unclear. This study aimed to compare three surgical techniques for LPA anastomosis in kidney transplantation, focusing on both short- and long-term outcomes. Methods: A retrospective cohort study was conducted at the Joint Stock Company "National Scientific Centre of Surgery named after Alexander Nikolaevich Syzganov" between January 2012 and August 2024. Forty-eight kidney transplant recipients with an LPA were analysed. Patients were grouped by surgical technique: Group 1 (end-to-side anastomosis of the LPA to the main renal artery), Group 2 (anastomosis of the LPA to the inferior epigastric artery), and Group 3 (side-to-side reconstruction between the main renal artery and the LPA). Intraoperative parameters, graft function, and complications were assessed. Results: The groups were comparable in demographics and baseline renal function. Cold ischaemia time was the longest in Group 3, whereas Group 2 had the longest recipient-phase operation time. Postoperative complications were similar across groups, with one Grade III-IV complication reported in Group 3. Graft function, measured by serum creatinine and glomerular filtration rate at 5 days, 1 month, and 1 year, showed no significant differences among groups. One-year graft survival was 100% for Groups 1 and 2 and 94% for Group 3. Conclusion: All three techniques yielded comparable graft function and survival rates, with minor variations in cold ischaemia time and complications. Tailoring the surgical approach to individual patient anatomy is critical for optimising outcomes in kidney transplantation involving an LPA.