EARLY OUTCOMES OF LIVING-RELATED DONOR KIDNEY TRANSPLANTATION WITH MULTIPLE RENAL ARTERIES: A RETROSPECTIVE COHORT STUDY WITH AN MSCT-GUIDED ARTERIAL RECONSTRUCTION FRAMEWORK

Multiple renal arteries increase the technical complexity of living-donor kidney transplantation. This retrospective single-center cohort compared fixed-time outcomes in 578 living-related donor kidney transplantations: 471 grafts had one renal artery and 107 had two or more. All donors underwent preoperative multislice computed tomography angiography with three-dimensional reconstruction, and reconstruction was individualized according to vascular anatomy. Because outcome events were sparse, two-sided Fisher exact tests and absolute differences in survival proportions with 95% confidence intervals were used. Multiple-artery grafts accounted for 18.5% of the cohort, and 101 of 107 had two arteries. Six-month graft survival was 97.9% for single-artery grafts and 97.2% for multiple-artery grafts (difference, -0.7 percentage points; 95% CI [-5.9, 1.9]; p = .716). Twelve-month graft survival was 96.2% and 96.3%, respectively (difference, 0.1 percentage points; 95% CI [-5.6, 3.2]; p = 1.000). Recipient survival showed no statistically detectable difference at 6 months (96.8% vs. 96.3%; p = .765) or 12 months (95.5% vs. 94.4%; p = .613). These unadjusted analyses do not establish equivalence or noninferiority. Selected multiple-artery living-donor grafts were feasible in this experienced center, but the proposed MSCT-guided planning framework and area-equivalent ostial diameter remain descriptive tools requiring further validation.

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