Técnicas vasculares en el trasplante renal complejo. La importancia de la planificación y estrategia multidisciplinar

Resumo

The current longer life expectancy of patients with chronic renal failure increases the prevalence of arterial disease and this gives rise to the existence of a group of patients who are candidates for renal transplantation with arterial disease that needs to be corrected to make it possible. There are certain conditions in which kidney transplantation can be considered "complex" either due to arterial or venous disease of the recipient's aortoiliac axis, or due to the difficulty of accessing the iliac vessels due to the conditioning of the surgical field, to which must be added Variability in graft morphology. Patients and methods. - 150 patients considered complex who were evaluated by the surgical team (Urology-Vascular Surgery) in the period from April 2016 to December 2019 are analyzed, the main objective of the study being to analyze the results of the 50 patients finally treated in comparison with all transplant patients between 2014 and 2019. Results. - Survival at one year were 94% for complex patients versus 97.3% for the control group (P=0.174) and at 2 years 95.1% and 92% respectively (P=0.337) There were no differences statistically significant of the complex patients with respect to the control in terms of primary function (92% - 93%; p = 0.053), delayed graft function (54.9% -50.2%; p = 0.52) and in the need for postoperative dialysis (49% - 48.1%; p = 0.51) Conclusions. - An adequate vascular evaluation in patients with complex arteriovenous pathology allows, by means of prior or simultaneous correction of the vascular pathology, kidney transplantation with results that are not inferior to the population group without vascular complications.