Anatomical variations of the renal vasculature and outcome of live donor nephrectomies: experience of a single surgeon

Introduction
Renal artery [RA] variations occur in 18 % to 21%. Variations determine the side selection in kidney donors and the outcome of Kidney Transplantation. This series reports the renal vascular anatomy [RVAS] variations and associated complications encountered during live donor nephrectomies [LDN].

Methods
Consecutive LDN done by a single surgeon is included, the patient's demography, LDN side, RVAS variations and complications are recorded. The kidney with worse function and the least number of RA is selected for LDN. The RVAS is assessed by Computed Tomography Angiography and intra-operatively. Single RA and vein with the hilar division are considered normal anatomy.  

Results
159 were included with 103 [64.8%] males. The mean age was 38.2 years [23-63]. 106 [66.7%] were left LDN. 136 [85.5%] had single RA of these 34 [21.4%] had early-branching [EB]. 23 [14.5%] had multiple RA [2 in 21 and 3 in 2]. Therefore variations occurred in 35.8 %. In a subgroup analysis of 123 renal veins, only 6 [6.8%] with single RA but 9 [25.7%] out of 35 with multiple arteries or EB arteries had multiple veins. This difference was statistically significant [p-0.004]. 11 [6.9%] had complications [3 renal bed haematoma]. 2 of 3 haematoma patients had EB of RA [5.9% vs. 0.8%] and underwent right LDN [3.8% vs. 0.9% / p>0.05].

Conclusions
RA variations occur in 35.8 %. Multiple arteries and EB is significantly associated with multiple veins. The complication rates in patients with EB appear to be high. However, this was not statistically significant probably due to low numbers.