The Finding of Vascular and Urinary Anomalies in the Harvested Kidney for Transplantation M. Santangelo, M. Clemente, P. De Rosa, M. Zuccaro, L. Pelosio, L. Caggiano, C. La Tessa, and A. Renda ABSTRACT Introduction. In kidney transplantation, anatomical vascular and excretory anomalies may represent causes of failure. Today’s surgical techniques have made the most of the organs with anatomic anomalies and iatrogenic injury successfully used for transplantation. Materials and Methods. From January 2000 to June 2006, we harvested 230 kidneys, of including 88 kidneys (20%) with vascular, urinary, or vascular-urinary anomalies; 64 kidneys were implanted and 15 were sent to other transplantation centers. Only 9 kidneys were not appropriate for transplantation. Results. All patients who received kidneys with the above-mentioned anomalies were carefully examined after the transplantation and short-term and long-term complications were evaluated with respect to controls without anomalies. Discussion. Renal anatomic anomalies are frequently observed during kidney transplanta- tion and may produce postsurgical complications. However, the presence of these anomalies does not necessarily imply the impossibility of using the kidney for a transplant, especially because of improved surgical techniques. Our experience in transplantation procedures showed that even if kidneys present the above-mentioned anomalies they can still be considered appropriate for transplantation when we perform a correct harvesting/back-table transplant surgery. So vascular and urinary anomalies have to be considered always an incentive to research new surgical solutions and to perform a careful surgical technique. N OT every harvested kidney is suitable for transplanta- tion. Anatomical anomalies of the vascular and excre- tory district represent frequent causes for discarding a kidney. Modern surgical techniques can overcome these problems. Various levels of anatomic anomalies exists; some are simple, some are complex, necessitating back-table correc- tions, but others are so complex that they do not allow transplantation. The harvested organs are classified as stan- dard or directly useable for transplantation, nonuseable for transplantation, or suboptimal if they require correction. Transplantation of suboptimal kidneys may be associated with a greater incidence of complications than seen in the control. 1,2 We established a procedure to define the characteristics of suboptimal kidneys and specifically select an appropriate recipient. We considered suboptimal all organs with complex arterial anomalies (more than 2 arteries on a single patch, 2 or more arteries that needed a separate anastomosis or a bench reconstruction) and organs with complex anomalies of the excretory tract (complete double district). 3 The aim of our study was to evaluate the incidence of anatomic anomalies in harvested kidneys and the incidence of postsurgical complications of suboptimal kidneys. MATERIALS AND METHODS From January 2000 to June 2006 we harvested 230 kidneys, yielding 431 organs, including 88 kidneys (20%) with vascular, urinary, or vascular-urinary anomalies. Sixty-four kidneys were transplanted in our center, 15 were sent to other centers because of the absence of a compatible recipient on our waiting list or organizational problems, and only 9 kidneys were not appropriate. Of 64 transplanted kidneys, From the General, Thoracic and Vascular Surgery Department (M.S., M.C., M.Z., L.P., L.C., C.L.T., A.R.), O.U. of General Surgery and Organ Transplantation, University of Naples “Fed- erico II,” and Transplant Unit (P.D.R.), AORN San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy. Address reprint requests to Michele Santangelo, MD, Via A. Diaz, 7, 80059 Torre del Greco, Napoli, Italy. E-mail: miichele. santangelo@unina.it © 2007 by Elsevier Inc. All rights reserved. 0041-1345/07/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2007.05.038 Transplantation Proceedings, 39, 1797–1799 (2007) 1797