Does the Presence of Renal Vascular Variation in the Renal Allograft Determine the Outcome of Renal Transplantation? Experience from the National Kidney Transplantation Center, Ethiopia

Background: Renal transplantation is the treatment of choice for people who suffer from end stage renal disease. Renal vascular anatomy is known for presenting a wide range of variations. Kidneys with variant renal vascular anatomy when used as a graft appear to be a potential risk factor that could impair the outcome of kidney transplantation. Information on renal vascular variations and its implication in the surgical outcome of renal transplantation has not been well studied. Hence, the present study was aimed to evaluate the outcomes of transplantation of renal allografts with variant renal vasculature as compared to allografts without renal vascular variation in the national kidney transplantation center of Ethiopia.Methods: A health institution based cross-sectional study was conducted. A retrospective review of the medical records of kidney recipients was performed. A total of 120 renal transplant recipient’s medical records were evaluated. Chi-square test and Independent t test was used to compare the surgical outcomes of renal transplantation. Graft survival was expressed using Kaplan-Meier curves, and was compared using the log-rank test. P values less than 0.05 was considered as statistically significant. Result: Evaluation of the renal transplant outcomes did not have shown a significant difference in the postoperative complication rate, rate of delayed graft function (DGF), creatinine clearance levels at 1 , 6, or 12 months postoperatively, and 1-year graft survival among recipients of allografts with and without renal vascular variations. However, operation time and the length of hospital stay were significantly longer among recipients of allografts with variant vasculature.Conclusion: No significant difference was noted in the outcomes of transplantation of renal allografts with and without vascular variations. Hence, renal allografts with vascular variations are safe to be recruited for transplantation as to this study.

A Case Report of Hepato Spleno Mesenteric Trunk – A Rare Vascular Variation

Major sources of the vascular supply of the gastrointestinal tract are the celiac trunk (CT) and superior mesenteric artery (SMA) which are the main proximal branches of the abdominal aorta. The CT gives rise to three branches normally as follows: left gastric artery (LGA), common hepatic artery (CHA) and splenic artery (SA). The branching pattern of the CT is considered as the most literature explained anatomical pattern.1 After the CT, the abdominal aorta gives the second named branch as superior mesenteric artery. Vascular variations of the celiac trunk and superior mesenteric artery are common and had been described earlier.2 These variations are caused due to the aberrant embryological development of splanchnic arteries. The incidence of hepato-spleno-mesenteric trunk has been reported by various authors as 0.68 %,3 0.7 %,4 0.3 %,5 0.4 %,6 or 1 %.7 The importance of knowledge of these variations lies in preplanning of invasive surgical techniques, organ transplantation, diagnosis, prevention, and management of some metastatic tumours and to overcome the catastrophic consequences like bowel ischemia due to common trunk.8 Hence a better understanding of these anatomical variations is considered vital for surgeons or radiologists for appropriate planning and conduction of surgical procedures or interventions.9 Most of the anatomical variations in abdominal aorta branches are asymptomatic and incidental findings while imaging for other aetiologies. But the identification of such vascular variations is of utmost importance in clinical practice. The Hepatospleno-mesenteric trunk [HSMT] is one of those variations and was less frequently reported. The authors describe a case report of the hepato-spleno-mesenteric trunk which was incidentally detected in the multi detector computed tomography study of the abdomen of a 54-year-old male patient who had been diagnosed to have chronic liver disease and hepatic encephalopathy. The origin of the HSMT [with a diameter of 11mm] occurs from the abdominal aorta at the level of the L2 vertebral body and is divided into the hepatosplenic trunk [diameter of 7 mm] and superior mesenteric artery [diameter of 7.5 mm] after coursing for a length of 28 mm. The hepatosplenic trunk ascends superiorly for a length of 20 mm and divided into two terminal branches: common hepatic (6 mm) and splenic artery (6 mm).