Dacron vascular grafts: a long-term solution for short renal vein challenges in living donor kidney transplantation in a retrospective case series.

PURPOSE: Short renal veins in living donor kidney transplantation present technical challenges during graft placement and vascular anastomosis. Artificial graft use raises concerns about infection and thrombosis. We share our experiences using Dacron vascular grafts (Hemagard, Maquet) for renal vein extension with long-term safety and efficacy. METHODS: We retrospectively reviewed 11 cases at Seoul National University Hospital (2016-2024) where Dacron vascular grafts were used for renal vein extension. Patient demographics, comorbidities, graft size, and postoperative antiplatelet therapy were analyzed. Imaging follow-up was performed with sonography before discharge. RESULTS: Patients had a median age of 56 years and a median body mass index of 25.0 kg/m2. Eight grafts involved the right kidney and three involved the left kidney. The median graft diameter was 12 mm. At discharge, median serum creatinine was 1.2 mg/dL and median estimated glomerular filtration rate was 63.7 mL/min/1.73 m2. Median follow-up was 46 months. One patient required reoperation due to bleeding unrelated to the graft. No thrombosis or stenosis was detected. Vascular patency was excellent in all cases during follow-up, aside from 1 death (pneumonia) and 1 graft failure from immunoglobulin A nephropathy recurrence. CONCLUSION: Dacron vascular grafts for renal vein extension in living donor kidney transplantation are a reliable and effective surgical option, demonstrating favorable long-term safety and patency without increased thrombotic or infectious complications under antiplatelet management.