Aortoiliac surgery concomitant with kidney transplantation: a single center experience

Introduction: Aortoiliac pathology in kidney allograft recipients is not rare but treatment timing is controversial. As most publications on this topic are case reports it's difficult to evaluate long-term outcomes of those clinical challenges. Herein we report long-term results of these procedures. Methods: From 1970 to 2006, 1544 kidney transplants were performed in our center. Thirty patients underwent aortoiliac surgery simultaneously with kidney transplantation. We analyzed their clinical records to come up with outcomes of these complex clinical challenges. Results: Vascular pathology was distributed as following: 19 stenoses treated with endarterectomy (15), aortoiliac bypass (two), aorto-bi-iliac bypass (one) and aorto-bifemoral bypass (one); and 11 aneurysms treated with arterioplasty (four), aorto-bi-iliac bypass (four) and iliac-iliac bypass (three). In 24 cases (80%) the necessity of vascular surgery was established intraoperatively as vessels' conditions did not permit safe anastomoses and jeopardized graft survival. Mean follow-up was 59 months (12-125). Five (16.7%) grafts were lost and three (10%) patients died in the first post-operative month: acute myocardial infarction (two) and non-viable kidney (one). Three patients died six, seven and 10yr after the procedure. Nineteen patients are currently well with functioning grafts. Conclusion: Surgical correction of aortoiliac pathology may be performed simultaneously with kidney transplantation with acceptable outcome. This complex surgery can be performed in centers with experienced vascular surgeons. Specific vascular imaging should be performed regularly on patient at risk of aortoiliac disease before insertion and while on waiting list.