Effect of Multi-Artery Renal Grafts on Patient Outcomes in Living Donor Kidney Transplantation

Abstract

BackgroundMultiple renal arteries (MRA) in a donor kidney can increase surgical complexity in living donor kidney transplantation. However, the impact of MRA on early transplant outcomes, including delayed graft function (DGF) and early graft failure, remains unclear.MethodsWe performed a single-center retrospective cohort study of 1,200 living donor kidney transplants conducted between 2019 and 2024. Donor kidneys were classified as having a single renal artery or multiple renal arteries (two or more). Recipient and donor characteristics, intraoperative details (ischemia times, vascular anastomosis technique), and postoperative outcomes (delayed graft function [DGF], primary nonfunction, and graft survival) were compared between the two groups. Logistic regression analyses were used to examine associations between MRA and the risk of DGF or graft failure within the first 90 days, both before and after adjusting for prespecified covariates.ResultsOf the 1,200 transplanted kidneys, 882 (73.5%) had a single artery and 318 (26.5%) had multiple arteries. Although the median cold-ischemia time was longer for multi-artery grafts (35.2 min vs. 29.4 min, p = 0.004), there were no significant differences in donor or recipient baseline characteristics. Multivariable logistic regression revealed no significant association between MRA and either DGF or early graft loss. Kaplan-Meier curves, censored for death, demonstrated similar graft survival in both groups (log-rank p = 0.25).ConclusionsIn this single-center cohort of living donor kidney transplants, grafts with multiple renal arteries did not exhibit an elevated risk of DGF or early graft loss. While additional surgical complexity is often required for MRA grafts, our findings suggest that these kidneys remain a safe and effective option for transplantation, supporting their broader use to expand the donor pool.