Background: Utilisation of renal allografts with multiple renal arteries (MRA) has always been considered a technical challenge during implantation of renal allografts. There is sparse literature comparing the implantation technique of MRA and allograft outcomes. The aim of this study was to perform systematic review and meta-analysis of literature comparing inferior epigastric artery (IEA) to other surgical anastomosis techniques in renal allografts with MRA.

Methodology: The database MEDLINE was searched via PubMed, EMBASE, The Cochrane Library. Grey literature search was utilised including GoogleScholar. We appraised the studies using Keywords and MeSH were utilised, including: “epigastric artery” AND “kidney transplant”. The studies were appraised using Newcastle-Ottawa scale and meta-analysed using random-effects model.

Results: A total of eight studies met the inclusion and exclusion criteria for analysis. Five studies were included in the quantitative analysis. Majority of the studies were poor (n=4) or fair (n=4). There were a total of n=846 patients in the studies, with n=161(19.0%) undergoing inferior epigastric artery anastomosis.  Other anastomosis techniques consisted of: side-to-side with single anastomosis, long or modified carrell patch, end to side to main renal artery with single anastomosis.  Nearly all of the renal allografts in the study population consisted of living donation kidney allografts.  In meta-analysis: there was no statistical difference in urological complication rate between IEA versus other techniques, O.R. 0.82 (CI 0.21, 3.24). There was a trend towards lower delayed graft function (DGF) in IEA versus other anastomosis techniques but it did not reach statistical significance (O.R. 0.45, CI 0.10, 2.02). In qualitative analysis, vascular complications were largely reported in one paper, with 3 in IEA vs 6 in other anastomosis group. Long-term graft function was only reported in one paper, with 2 (9.5%) in IEA vs 47(16.2%) in other anastomosis group. Overall follow-up ranged from 12 months to 10 years, with none reporting long-term patient survival.

Conclusion: Utilisation of recipient inferior epigastric artery for accessory polar vessels is an acceptable technique in renal transplantation. Whilst no short-term differences were shown in peri-procedural vascular or urological complication, there was a trend towards reduced delayed graft function. Long-term impact on graft function remains to be determined.