الفهرس 
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Abstract
This work was dedicated to specifically study the vascular surgical aspect of the kidney transplantation procedure in a multi-specialty highly qualified team. The points of interest were to highlight the preoperative and intraoperative factors related to vascular surgery that would affect the outcome of the transplantation operation.
This surgical team operated in two different settings; till 2017, the surgeons operating upon the recipient were urosurgeons with excellent experience in transplantation (Team A). Since 2017, a vascular surgeon had joined the recipient team (Team B) thus enabling us to compare the two sets of operating personnel and to describe the difference in their techniques and outcomes.
During the study, a third group (Team C) evolved as this was strictly a team A case where they required urgent intraoperative notification of a vascular surgeon to manage unexpected vascular complication or technical difficulty.
Each recipient and donor were studied meticulously through their preoperative, intraoperative and postoperative data.
Preoperative recipient’s data of interest were with the personal data, history of his renal condition, dialysis, co-morbid factors, surgical history, relevant laboratory results and radiological workup.
Preoperative donor’s data of interest were the personal data, medical conditions, surgical history, relevant laboratory results and radiological work up mainly renal isotope scan and CT renal angiogram.
Intraoperative details were meticulously studied; the operating team, donor’s technique, recipient’s technique with special attention to vascular anastomotic details (anastomotic configuration and recipient artery), graft morphology and anomalies with special attention to the number and size of the renal vessels and the techniques used to spare multiple renal arteries and veins in addition to the total procedure and clamping duration.
Immediate graft reperfusion changes like colour, texture, initiation of urine production and its volume were also recorded and statistically examined for their relation to any of the studied technical varieties.
Postoperatively, the recipient and donor’s conditions were traced including ICU stay duration, volume of urine collected during the first postoperative hours (first, second, third, total twenty-four and forty-eight hours).
Donors and recipients were followed up to ensure smooth recovery and complications were identified, recorded and traced till their resolution with special attention to those of vascular origin (hematomas, lymphoceles, thrombosis, renal artery stenosis, ruptured grafts and ipsilateral limb edema) and the management of each.
Follow-up was done to each of our patients, the minimum follow up of the included cases was one year, some included cases completed four years of follow up. The cornerstone of follow up being the serum creatinine level and whether any complications were recently developed.
All previously mentioned data were collected, sorted, ant treated with appropriate statistical methods to outline the significant results and relations among the different studied issues.
A total of fifty cases were performed; twelve cases by team A, thirty-five cases by team B and only three cases by team C.
Among the fifty cases; forty-eight were concluded with technical success and two cases were failed transplantation primarily at time of surgery.
Two cases failed primarily; one in team (A) due to multiple repeated graft thrombosis, and the other is a Team (C) case that failed due to a ruptured graft on top of venous impairment that resulted from a post-phlebitic diseased external iliac vein of the recipient.
Different relations that affected the outcome were studied, while the outcome was split into immediate and delayed outcome, the most significant relations found were;
Better immediate outcome in the form of more urine volumes recorded in the early postoperative hours were with younger recipient ages, less recipient’s body weight, patients with shorter durations of renal disease, patients that had performed dialysis for less durations of time, grafts anastomosed to the common or external iliac arteries via an end to side fashion, patients with no recipient artery disease and those with shorter clamping, cold ischemia and total procedural times.
Most of the previously mentioned factors contributed to the final conclusion that team (B) cases responded better in the early post-operative period than cases of team (A).
Among the forty-eight successful cases; thirty-seven experienced a smooth eventless recovery while eleven patients experienced surgical complications; four hematomas, four lymphoceles, three urine leaks, three cases of ipsilateral lower limb edema and two incisional hernias.
It was noted that the incidence of hematoma and lymphocele’s formation varied among the two operating teams; team (A) recorded two cases of hematomas out of twelve (16.6%) and two case of lymphoceles out of the twelve cases (16.6%), while team (B) recorded two cases of hematoma out of their thirty-five cases (5.7%) and another two case of lymphoceles (5.7%) denoting a significant variability of incidences among the two teams.
None of the donors developed surgical complications, and none of the recipients developed anesthesia related complications, surgical site infections or renal artery stenosis upon regular follow up.
Concerning longer term follow-up, forty-six patients completed one year of follow-up with an average serum creatinine level of 1.15. Twenty six patients completed two years of follow up and their average serum creatinine level was 1.23. Eight patients completed three years of follow-up, their average serum creatinine level was 1.41. And three patients completed four years of follow up, their average serum creatinine level was 2.13. Average patient survival rate after two years was 93%. Both, survival rates and follow up serum creatinine did not vary among team A and team B results.
Certain factors were noted to correlate to significntly lower values of serum creatinine upon serial follow-up which were; female gender, recipients with less body weight, recipients with preoperatively lower values of urea, creatinene and calcium, recipients with waiting time for transplantation that is less than six months and finally donors who are younger in age.