Fate of Accessory Renal Arteries in Grafts with Multiple Renal Arteries during Live-Donor Renal Allo-Transplantation A.M. Harraz, A.A. Shokeir, S.A. Soliman, A.S. El-Hefnawy, M.M. Kamal, I. Shalaby, A.I. Kamal, and M.A. Ghoneim ABSTRACT Introduction. To determine risk factors for and the effects of impaired perfusion (IP)—“reduced or non-perfusion”— of graft areas supplied by an accessory artery on allograft function. Objectives. One hundred five consecutive grafts with multiple renal arteries were prospectively evaluated using Doppler ultrasound (US) to detect the perfusion of allograft segments supplied by the accessory artery. We studied factors predicting and the effects of IP on graft function. Results. Doppler US diagnosed IP of allograft accessory arteries in 11 (10.5%) allografts. Mean values  standard deviations and median (range) of renographic clearance of grafts with IP were 50.5  26 and 40 (range, 21–92) mL/min, while those of grafts with patent accessory arteries were 68.6  18.9 and 67.2 (range 21–117; P  .01). The percentage change in renographic clearance before versus after transplantation increased among grafts with patent arteries and decreased for those with IP (P = .03). On multivariate analysis, factors predicting IP of the accessory artery were delayed graft function (odds ratio [OR] = 9.9; 95% confidence interval [CI] = 1.6 –58.6; P = .01) and upper polar arteries (OR = 8.9; 95% CI = 1.8 – 43.4; P  .01). Conclusion. When considering transplants with accessory arteries, greatest attention and efforts should be exerted on upper polar arteries to avoid delayed graft function. D ONOR GRAFTS WITH MULTIPLE ARTERIES are accepted to expand the inclusion criteria for renal transplant programs. Although some complications have been reported, 1,2 they show comparable survivals to grafts without them. 3–5 Even laparoscopic procurement has shown safety and feasibility in hands of experienced trans- plant surgeons. 6–9 Surgical techniques to anastomose accessory arteries are well known. 10 –13 Nevertheless, neither radiological evidence of the patency of the accessory artery nor the effect of postoperative occlusion of the accessory arteries on graft outcomes has not been widely studied. We sought to determine whether the occlusion of the acces- sory graft artery as determined by impaired perfusion (IP) of the area of the graft supplied by the accessory artery affected early graft function. Secondarily, we aimed to define factors responsible for patency of the accessory artery to maximize perfusion and optimize graft outcomes. METHODS Study Population After obtaining our institutional review board acceptance, we performed a retrospective study to identify functional and anatom- ical outcomes of living donor renal allografts bearing multiple renal arteries between November 2002 and January 2011. Among 731 grafts procured using an open approach 108 bore multiple arteries of which full imaging data were available for 105 cases. Retrieved data included baseline characteristics and demographic features of donors and recipients together with anatomical and functional From the Urology Department (A.M.H., A.A.S., S.A.S., A.S.E.-H., M.M.K., M.A.G.), Radiology Department (I.S.), and Nephrology Department (A.I.K.), Urology and Nephrology Cen- ter, Mansoura University, Mansoura, Egypt. Address reprint requests to Ahmed A. Shokeir, MD, PhD, FEBU, Professor of Urology, Editor-in-Chief Arab Journal of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. E-mail: ahmed.shokeir@hotmail.com 0041-1345/13/$–see front matter © 2013 by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.transproceed.2013.02.030 360 Park Avenue South, New York, NY 10010-1710 1232 Transplantation Proceedings, 45, 1232–1236 (2013)