Surgical treatment of aortoiliac aneurysms in renal transplant patients.

PURPOSE: The purpose of this study was to report our experience of surgical treatment of aortoiliac aneurysms in kidney transplant patients, to describe technical problems of this surgery, to evaluate its long-term outcome, and to discuss the place of endovascular repair.
METHODS: Eighteen patients who had undergone renal transplantation 3 months to 23 years earlier (mean: 6 years) were operated on for an aortoiliac aneurysm. In 15 patients (83%), no protective measure of the kidney was used. In seven patients, the reconstruction remained proximal to the renal artery whereas in 11 patients it required the reattachment of the artery to the prosthesis.
RESULTS: There was no mortality after the operation. A moderate increase of blood creatinine occurred in all patients but by the end of the tenth postoperative day, all patients had regained renal function identical to the preoperative state. In the long-term follow-up, nine late deaths occurred, mainly due to myocardial infarct (N = 7), and chronic rejection led to hemodialysis in three patients. Six patients are alive with a functioning transplant. The follow-up ranges from 5 to 30 years.
CONCLUSION: Open repair of aortoiliac aneurysms can be safely undertaken in renal transplant recipients without protection of the transplanted kidney. In the long-term follow-up, these patients are exposed to complications of general arteriosclerosis and to rejection of their transplanted kidney. Aortic aneurysms following kidney transplantation are likely to become more frequent in the future due to extension of renal transplantation to older and severely arteriosclerotic patients.