# End-to-Side Reconstruction for Two Renal Arteries Affects the Recovery of the Graft Function in Living Donor Renal Transplantation

## TL;DR

This study examines how different artery reconstruction methods affect kidney transplant outcomes, finding that end-to-side reconstruction may lead to worse results.

## Contribution

The study identifies end-to-side reconstruction as a potential risk factor for delayed graft function and reduced long-term survival in kidney transplants.

## Key findings

- End-to-side reconstruction was associated with significantly higher delayed graft function recovery.
- There was a trend toward increased all-cause graft loss in the end-to-side group.
- Other reconstruction methods did not show significant differences in outcomes.

## Abstract

Background/Objectives: Kidneys with multiple arteries are occasionally encountered in living-donor renal transplantation. However, the impact of different reconstruction methods on graft outcomes remains unclear. Therefore, we aimed to analyze the effect of the end-to-side reconstruction technique on short- and long-term outcomes in living donor renal transplantation.

Methods: We retrospectively analyzed 254 living donor renal transplants performed at our center between 2011 and 2024. Sixty patients with dual renal arteries were categorized into five groups based on the type of reconstruction method: end-to-side (n=5, 2.0%), inferior epigastric artery (n=15, 5.9%), direct anastomosis (n=2, 0.79%), side-to-side (n=29, 11.4%), and ligated (n=9, 3.5%). Furthermore, we compared the incidence of early postoperative events and long-term survival with those of a control group of single-artery transplants. Long-term survival was analyzed using Kaplan-Meier and Cox regression analyses. Cox regression was adjusted for several factors.

Results: The end-to-side group had a significantly higher incidence of delayed graft function recovery (p<0.001) and a trend toward increased all-cause graft loss (p=0.254) compared with the control group, whereas other groups showed no significant difference.

Conclusions: Our study showed a higher incidence of delayed graft renal function recovery and inferior long-term graft survival only in the end-to-side group. Further multicenter studies are required to evaluate alternative reconstruction techniques.