Vascular inflow after renal transplantation: Does the arteriotomy technique impact early allograft perfusion and function?

Background: There are two main techniques for arterial reconstruction in RT: TA using a stab longitudinal incision which creates an elliptical opening and AP which fashions a circular defect. We hypothesized that AP creates a natural anastomosis lumen, similar to the donor renal artery, which optimizes RT perfusion. Methods: A retrospective review of a single-institution database was performed between 2000 and 2018. Twenty patients who underwent AP arteriotomy were compared to 40 TA-matched controls. Data were collected on creatinine (preoperative, nadir, and time to nadir), and DUS RI and PSV at 1 week, 3 months, and 6-12 months post-RT. Results: ttNC was shorter in the AP group (5 ± 4 vs 12 ± 13 days; P =.03). PSV at 1 week was lower in the AP group (186 ± 65 cm/s vs 232 ± 89 cm/s; P =.04). There was no difference in nadir creatinine value (P =.26), preoperative creatinine (P =.66), and initial postoperative creatinine (P =.80). RI at week 1 were not different between groups (P =.37). Follow-up DUS showed the difference in PSV between groups became non-significant (1 month P =.50 and 6-12 months P =.53). Conclusions: AP arteriotomy in RT improves early perfusion and function parameters (ttNC and initial PSV) as compared to TA. AP arteriotomy optimizes early allograft reperfusion, which may have important long-term implications and deserves further evaluation.