Use of vascular clipping system in kidney transplantation in syria: a study of 30 cases.

The aim of this study is to report our experience in the use of vascular clipping system (VCS) in kidney transplantation (KT), and to discuss its potential clinical benefits for the patients compared with the traditional anastomosis method (suture method). Between October 1985 and December 2000, 350 cases of KT from living related donors (LRD) were performed in the Kidney Transplantation Unit at the Al-Mouassat University Hospital in Damascus, Syria. Between October 1999 and December 2000, 30 cases (21 males and 9 females) of KT were performed using VCS. The mean age of the patients was 32.7 years (14-52). HLA typing showed HLA haplo-identical matching in 22 patients and HLA identical matching in eight. Twenty left kidneys and 10 right kidneys were resected from LRD. VCS was used in 22 arterial and 30 venous anastomosis. We used the Vascular Clip Applier/large 2.0-Auto suture Company-Connecticut-USA. Vessel anasto-mosis was performed end to end between renal and hypogastric arteries and end to side between renal and external iliac vein for all 30 patients. Immunosuppression treatment was with cyclosporine, azathioprine and prednisolone in all patients. The follow-up period was 5-16 months. All the patients were alive at the end of the follow-up period. The other cases of KT (320 patients) were performed by traditional anastomosis method (suture). The time of arterial anastomosis was 12-20 minutes (mean 16) for the suture method versus 7-10 minutes (mean 7.5) for the VCS method The time of venous anastomosis was 15-25 minutes (mean 20) for the suture method versus 7-9 minutes (mean 8.5) for the VCS method. The number of transfused packed red cell units per operation was 1-2 units in the suture method versus 0-1 unit in the VCS method. We observed 17 cases of acute tubular necrosis (ATN) in the 320 cases in whom the suture method was used versus no case in the 30 patients receiving VCS. Vascular anastomosis using VCS shortens the warm ischemia time, reduces packed red cell units transfused and the occurrence of ATN, and thus improves the function of kidney graft.