The use of polytetrafluoroethylene graft for damaged renal artery in ABO-incompatible living donor kidney transplantation: a case report

Abstract

Short donor renal vessels during donor nephrectomy represent a technical challenge. The allograft of vessels from deceased donors can be an option for reconstruction; however, cryopreserved vessels are not routinely prepared for living donor kidney transplantation (LDKT). We report a reconstruction of the damaged short renal artery (RA) in LDKT using a polytetrafluoroethylene (PTFE) graft. A 45-year-old male patient underwent ABO-incompatible LDKT from his wife. After donor nephrectomy, we detected a hematoma surrounding the proximal RA of the allograft. The injured segment of the RA was transected, and the short RA was connected to the right external artery of the recipient; however, the blood flow was interrupted by the graft location. Once the arterial anastomosis was removed, the graft was flushed with cold saline, and a PTFE graft was used for the reconstruction of the short RA. Immediate blood flow to the renal graft was excellent without sign of parenchymal infarction until fascial closure. Renal graft Doppler on postoperative day 7 and 3 months showed good blood flow. In this patient, the use of PTFE graft presented no additional morbidity to the kidney transplantation, and no postoperative complications related to its use were noted.

Keywords: Kidney transplantation; Living donor; Polytetrafluoroethylene; Renal artery.

Fig. 1

Anti-A isoagglutinin titers of recipient with plasmapheresis and rituximab administration. PP, plasmapheresis; POD, postoperative day.

Fig. 2

Three-dimensional computed tomography scan of the donor. A single artery was confirmed in each kidney.

Fig. 3

Short renal artery was reconstructed using polytetrafluoroethylene vascular graft. Renal parenchyma is well perfused after anastomosis.

Fig. 4

(A) Non-contrast computed tomography scan on postoperative day (POD) 5 showing mild peri-graft fluid, likely a hematoma. (B) Kidney Doppler on POD 7 showing good vascular flow within the normal range of restrictive index (RI; 0.59). (C) Follow-up kidney Doppler 3 months after surgery showing good intra- and extra-renal arterial flow within the normal range of RI (0.72).

Fig. 5

Pre- and postoperative creatinine (Cr) levels of the recipient. Serum Cr level reduced in the first 3 days after transplantation and maintained around 1 mg/dL. The last two Cr values (postoperative day [POD] 20 and 27) were measured in the clinic after discharge. PrOD, preoperative day.