Comparing anastomosis techniques on ischemia time in multi-arterial kidney grafts: a systematic review and meta-analysis

Authors

  • Bayu Hernawan Rahmat Muharia Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Gerhard Reinaldi Situmorang Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Nur Rasyid Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Arry Rodjani Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Ponco Birowo Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.13181/mji.oa.257527

Keywords:

ischemia, meta-analysis, renal artery, surgical anastomosis

Abstract

BACKGROUND Kidney transplants with multiple renal arteries (MRAs) address donor shortages but carry higher vascular risks than single renal arteries. This study aimed to evaluate how different anastomosis techniques affect outcomes in kidney transplants with MRAs through meta-analysis and systematic review, concluding the continuous discussion about the best reconstructive strategy.

METHODS A comprehensive search across 5 databases (PubMed, ScienceDirect, Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature) was conducted until December 17, 2024, to find studies comparing anastomoses technique in MRA grafts. Meta-analysis was performed using Review Manager software version 5.4, generating pooled effect estimates for mean difference (MD) and risk ratio (RR), two-sided p-values, and 95% confidence intervals (CIs).

RESULTS Two retrospective cohort studies were included in the meta-analysis. There was no significant difference between end-to-side and side-to-side anastomosis in warm ischemia time (MD = 15.64, 95% CI: −6.82−38.10, p = 0.17) or cold ischemia time (MD = −16.74, 95% CI: −105.61−72.14, p = 0.71). The complication rate showed no significant variation between side-to-side and end-to-side anastomosis (RR = 2.38, 95% CI: 0.41−13.70, p = 0.33). Meta-analysis on graft function and rejection was impossible due to differences in measurements and the small number of studies.

CONCLUSIONS Different anastomosis techniques for MRA grafts did not result in longer ischemia times or higher complication rates. Graft function and rejection rates were comparable between side-to-side and end-to-side anastomosis, suggesting both were equally feasible for renal transplants with MRAs. Further studies are required to verify these findings.

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References

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Published

2025-03-27

How to Cite

1.
Hernawan Rahmat Muharia B, Situmorang GR, Rasyid N, Rodjani A, Birowo P. Comparing anastomosis techniques on ischemia time in multi-arterial kidney grafts: a systematic review and meta-analysis. Med J Indones [Internet]. 2025 Mar. 27 [cited 2025 Apr. 2];34(1):30-6. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/7527

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Section

Clinical Research

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