Vascular and Nonvascular Challenges in Renal Transplantation: A Retrospective Single-center Analysis from North East India
Sasanka Kumar Barua, Rahul Kushwaha, Debanga Sarma, Puskal Kumar Bagchi, Mandeep Phukan, Nabajeet Das, Hiranya Deka, Mustafa Abdur RhamanBackground:
Renal transplantation is the definitive treatment for end-stage renal disease. However, both vascular and nonvascular complications can significantly affect graft and patient outcomes. This study retrospectively evaluates such challenges in our institution.
Materials and Methods:
We retrospectively reviewed 100 renal transplantations performed at our institution. Data were collected on intraoperative anatomical variations, postoperative complications, and their management. All donor nephrectomies are being done laparoscopically while vascular anastomoses follows no ligation protocol.
Results:
Multiple renal arteries were found in 11% of cases of renal donor, eight with double arteries and three with triple arteries. Equal-caliber double arteries were managed using pantaloon technique; while arteries with unequal calibers required separate anastomoses. Triple arteries were managed using a no-ligation strategy. One donor exhibited dolichoectasia of the aorta and renal artery with atheromatous plaques, requiring atherectomy. Two patients developed mycotic aneurysms, requiring graft nephrectomy. Urological complications included ureteric stricture and complete duplication, managed via uretero-ureterostomy. One patient with low bladder capacity (120 ml) demonstrated posttransplant adaptive remodeling to 300 ml. Dialysis-dependent female with refractory pseudoporphyria underwent transplant, with complete lesion resolution by the postoperative day-22. Among five ABO-incompatible and four deceased donor transplants, one ABO-incompatible recipient developed fulminant necrotizing pancreatitis and succumbed on day 2, while another developed nonhealing wound by
Conclusion:
Vascular anomalies, infectious complications, and ureteric challenges and some unusual entity can substantially impact the transplant outcomes. Tailored surgical approaches and multidisciplinary care ensured successful management, emphasizing institutional preparedness and technical innovation in renal transplantation.