Donor aortic cuff reduces the rate of anastomotic arterial stenosis in pediatric renal transplantation.

A total of 333 pediatric renal transplantations performed at our institution between January 1977 and July 1994 was retrospectively reviewed to provide guidelines for minimizing the incidence of transplant renal artery stenosis. The patients who had renal artery stenosis were 3 months to 17.5 years old (median age 9.3 years) at the time of transplantation and the condition was diagnosed 2.2 months to 2.5 years (median 4.2 months) after transplantation. Renal artery stenosis was diagnosed in 19 transplants (19 of 333, 5.7%) as a result of severe hypertension or renal function deterioration. Stenosis occurred at the anastomosis in 7 cases (37%) and distal to the anastomosis in 12 (63%). Transplantations performed with a donor aortic cuff resulted in a lower rate of renal artery stenosis at the anastomosis (0 of 193, 0%) compared to those performed without a cuff (7 of 140, 5.0%, p = 0.0021). The rate of renal artery stenosis distal to the anastomosis was not different regardless of whether a cuff was used (5 of 193 cases, 2.6%) or not (7 of 140, 5.0%, p = 0.37). End-to-end anastomoses to internal iliac arteries, which were always performed without cuffs, had a particularly high rate of renal artery stenosis (3 of 10, 30%) compared to end-to-side anastomoses performed without cuffs (4 of 130, 3.1%, p = 0.0080). Bench surgery or multiple renal arteries did not adversely influence the rate of renal artery stenosis. With prompt diagnosis and treatment the actuarial graft survival of the transplants with renal artery stenosis was similar to that of the transplants without renal artery stenosis (p > 0.05).