Vascular complications after live donor renal transplantation: study of risk factors and effects on graft and patient survival.

UNLABELLED: We evaluated the incidence and management of vascular complications after live donor renal transplantation. Possible risk factors and their effects on patient and graft survival were also assessed.
MATERIALS AND METHODS: A total of 1,200 consecutive live donor renal transplants were performed in 1,152 patients at a single institution. The incidence of different types of vascular complications were determined and correlated with relevant risk factors. The impact on patient and graft survival was also studied.
RESULTS: There were 34 vascular complications (2.8%). Stenotic or thrombotic complications were recorded in 11 cases (0.9%), including renal artery stenosis in 5 (0.4%), renal artery thrombosis in 5 (0.4%) and renal vein thrombosis in 1 (0.1%). Hemorrhagic complications were observed in 23 patients (1.9%). Although no risk factors could be identified that were related to stenotic or thrombotic complications, grafts with multiple renal arteries were significantly associated with hemorrhagic complications (p = 0.04). Stenotic and thrombotic complications as well as hemorrhagic complications were significantly associated with subsequent biopsy proved acute tubular necrosis (p <0.001). The mean 5-year patient and graft survival rates +/- SD for those with vascular complications were 71.9% +/- 1.9% and 41.6% +/- 8.9% compared with 86.3% +/- 1.1% and 76.8% +/- 1.4% for the remainder of our transplant population, respectively (p <0.001). The deleterious impact on survival was not only observed in recipients with thrombotic or stenotic crises, but also in those with hemorrhagic sequelae.
CONCLUSIONS: Hemorrhagic crises are as serious as the stenotic and thrombotic complications affecting patient and graft survival. Because they are a significant factor in the development of hemorrhagic complications, grafts with multiple renal arteries should be managed critically.