Vascular reconstruction in monolateral dual kidney transplantation with multiple arteries The increasing number of patients on the waiting list, the shortage of kidneys for transplantation and the increasing age of deceased kidney donors, has prompted many transplant centers to accept grafts from older donors (1, 2). While there is a well- documented negative effect of an age-related nephron mass on graft survival, dual kidney transplantation (DKT) may counterbalance this expected lower graft function by transplanting two kidneys in the same recipient (1–4). DKT is now performed in many transplant centers with various surgical techniques. DKT is a major surgical procedure and has a potentially greater risk of surgical complications compared with single kidney transplantation. While most transplant centers adopted bilateral placement of the kidneys, monolateral placement of both kid- neys has recently emerged as a viable surgical option for DKT resulting in a significant reduction in the operative time with optimal result at medium term follow-up (3). The monolateral technique of DKT, however, may be challenging as it requires an extensive vascular dissection and a higher risk of renal vein thrombosis and may be contraindi- cated in presence of grafts with multiple arteries (3). We report a series twelve patients who under- went a monolateral dual kidney transplantation with grafts with multiple arteries, requiring a vascular reconstruction. Patient and methods From January 2002 to December 2009, 42 patients underwent DKT. The kidneys were selected for use according to the donorÕs characteristics and renal histology, as previously described (5). In brief, the changes in each evaluated component of the kidney tissue (e.g., vessels, glomeruli, tubules, and con- nective tissue) received a score of 0–3: 0, no changes observed and £ 3, marked changes Veroux M, Giuffrida G, Ekser B, Sinagra N, Giaquinta A, Leonardi A, Veroux P. Vascular reconstruction in monolateral dual kidney transplantation with multiple arteries. Abstract: We report the results of monolateral dual kidney transplantation with grafts with multiple arteries. Among the 42 monolateral DKT per- formed in a seven-yr period, 12 (28.5%) patients received renal grafts with multiple arteries. In six patients, the accessory arteries were anastomosed end-to-side or side-to-side on the aortic patch. In six patients, with three or more accessory arteries, a vascular reconstruction with an inferior vena cava patch was performed, before implanting the kidney. There were no intra- operative complications in the entire series, and there were no immediate vascular complications. Vascular reconstruction of kidneys with multiple arteries may be performed safely even in monolateral dual kidney trans- plantation. Inferior vena cava may be an attractive alternative in vascular reconstruction for kidneys with multiple arteries. Massimiliano Veroux, Giuseppe Giuffrida, Burcin Ekser, Nunzia Sinagra, Alessia Giaquinta, Alessandra Leonardi and Pierfrancesco Veroux Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced technologies, University Hospital of Catania, Catania, Italy Key words: dual kidney transplantation – expanded criteria donor – inferior vena cava – kidney transplantation – monolateral – multiple arteries Corresponding author: Massimiliano Veroux, MD, PhD, Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies, University Hospital of Catania, Via Santa Sofia, 83 95128 Catania, Italy. Tel.:+39 095 3782206; fax: +39 095 3782358; e-mail: veroux@unict.it Conflict of interest: None. Accepted for publication 4 May 2011 Clin Transplant 2012: 26: 443–446 DOI: 10.1111/j.1399-0012.2011.01537.x ª 2011 John Wiley & Sons A/S. 443