"Triple V-Plasty": Creation of a Single Orifice for Three Renal Arteries in Live-Donor Transplantation

Sujit Vijay Sakpal; Kyler Hardie; Eliza Peters; Hector Saucedo-Crespo

doi:10.1016/j.transproceed.2023.03.094

"Triple V-Plasty": Creation of a Single Orifice for Three Renal Arteries in Live-Donor Transplantation

Transplant Proc. 2023 Oct;55(8):1900-1902. doi: 10.1016/j.transproceed.2023.03.094. Epub 2023 Jul 19.

Authors

Sujit Vijay Sakpal¹, Kyler Hardie², Eliza Peters³, Hector Saucedo-Crespo⁴

Affiliations

¹ Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, South Dakota; Department of Surgery, University of South Dakota: Sanford School of Medicine, Sioux Falls, South Dakota; Department of Internal Medicine, University of South Dakota: Sanford School of Medicine, Sioux Falls, South Dakota. Electronic address: sujit.sakpal@avera.org.
² Sanford School of Medicine: University of South Dakota, Sioux Falls, South Dakota.
³ Department of Biology & Microbiology, South Dakota State University, Brookings, South Dakota.
⁴ Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, South Dakota; Department of Surgery, University of South Dakota: Sanford School of Medicine, Sioux Falls, South Dakota.

PMID: 37479542
DOI: 10.1016/j.transproceed.2023.03.094

Abstract

Background: Donor renovascular anatomic variations can hinder renal transplantation (RT), especially from live donors. Back-table vascular reconstruction can be effective in the use of renal allografts with multiple renal arteries (RAs), helping to expand the pool of live donors.

Surgical technique: Sequential V-plasty of 3 donor RAs using fine, non-absorbable, monofilament (7-0 or 8-0 polypropylene) suture in an uninterrupted fashion successfully enabled the creation of a single, wide ostium for anastomosis with the target inflow recipient artery.

Results: Creation of a single ostium for 3 RAs was successfully performed on a 31-year-old man during a live-donor left RT, resulting in good inflow and outflow with arterial and venous anastomoses, respectively, at graft implantation. Excellent postoperative allograft perfusion was achieved, and the patient continued to have normal allograft function at >1 year post-transplantation.

Conclusions: Novel ex vivo renovascular reconstruction potentiates expansion of live-donor RT successfully despite variant renovascular anatomy.