Long-Term Outcomes and Survival in Patients Undergoing Multiple vs. Single Renal Artery Transplants: A Retrospective Cohort Study.

Introduction The incidence of end-stage renal disease (ESRD) is increasing, and strategies are needed to expand the available kidney donor pool. Urologists have not preferred multiple renal artery (MRA) grafts due to concerns about higher complication rates. This study aimed to compare graft and patient survival post-transplant, complications, and the time taken to reach the nadir creatinine levels. Methods The records of 185 patients who had undergone renal transplants in a tertiary care center in Puducherry from 2012 to 2021 were collected and were divided into two groups: Single renal artery (SRA) graft recipients in group 1 and MRA graft recipients in group 2, and was further subdivided into deceased and live donor grafts, and further data were retrieved from the case sheets, master chart maintained by the Nephrology and Urology departments and Healthcare Information System (HIS) web portal. Results The mean age of group 1 was 33.54±10.44 and for group 2 it was 33.18±10.32 years, gender distribution and BMI of the two groups were also similar. The two-year graft survival for the SRA group was 76.06%, and for the MRA group was 81.25%. For the two years of patient survival, the SRA group had 85.43% survival and the MRA group had 81.25% survival. The creatinine returned to nadir level by day 5 to day 7 post-transplant for both groups. Also, the development of various complications in the post-transplant period was similar in both groups; however, the MRA group who underwent deceased donor transplants faced a higher risk of complications of the transplant operation. Conclusion This study demonstrates that kidney transplants using MRA grafts yield comparable outcomes to SRA grafts, despite challenges such as longer ischemia times and higher complication rates. Larger, multi-center studies are needed to further evaluate MRA grafts and optimize surgical approaches for broader donor inclusion.