Blood pressure control and renal function preservation of ex vivo renal artery repair with orthotopic renal autotransplantation for complex renal artery diseases

Objective: To assess the outcome of ex vivo renal artery repair with orthotopic renal autotransplantation for patients with complex renal artery disease. Methods: The single-center study collected and analyzed the data from patients with complex renal artery disease undergoing ex vivo renal artery repair with orthotopic renal autotransplantation, retrospectively. Results: A total of 21 complex renal artery lesions from 19 patients were included. The mean blood pressure showed a significant decrease from the preoperative to the postoperative period (P <.05). Renal function kept stable for the perioperative period. No significant serum creatinine and estimated glomerular filtration rate alteration was observed compared with the immediate postoperative period (P = .439 and .904, respectively). The median renal cold ischemia time was 35.5 (76) minutes. Two patients developed perioperative complications, one with acute cholecystitis and one with acute renal failure after graft occlusion in a solitary kidney. During the median follow-up of 48 months, one single bypass graft of a solitary kidney was occluded, and four grafts developed restenosis. The primary and primary-assisted patency rates at the 5-year follow-up were 81.3% and 87.5%, respectively. No deaths were observed in the follow-up period. Conclusions: Ex vivo renal artery reconstruction with orthotopic renal autotransplantation in patients with complex renal artery disease offers stable control of blood pressure and renal function preservation, and should be considered as a potential alternative for other open surgical procedures.