Left renal vein harvest for vascular reconstruction: Long-term renal outcomes

Abstract

Purpose: The left renal vein (LRV) may be harvested for use as a venous graft during vascular reconstructions. This study analysed renal outcomes after hepato-pancreato-biliary surgery with portal vein/superior mesenteric vein (PV/SMV) resection, comparing patients who underwent LRV harvest for vascular reconstruction against controls without LRV harvest. Methodology: In this retrospective cohort study, PV/SMV resections performed between Jan 2008 and Dec 2014 were identified from prospective institutional databases, and all circumferential resections were included in the analysis. Absolute levels and change from preoperative baseline in Creatinine (Cr) and Cockcroft-Gault GFR were measured at short and long-term time points, comparing LRV and control groups. Results: Of 107 PV/SMV resections, 76 had circumferential resection, with 17 in the LRV group and 59 in the control group. Mean follow-up was 18.7 months. There were no significant differences in demographics and baseline data between the LRV and the control groups, except for longer operative time in LRV group (615.6 vs. 480.0 min, p = 0.0016). There was no difference in absolute Cr and GFR between the groups at all time points (GFR LRV 103.1/91.4/91.1/95.2/91.4/79.4/72.2 vs. control 91.1/86.3/100.6/ 102.4/97.4/95.0/82.4 ml/min at preop/1d/3d/7d/3m/1y/3y). There was a difference in change in GFR during the first week (deltaGFR LRV vs. control at 3 days −12.0 + 41.5 vs. 9.5 + 18.6, p = 0.009; and at 7 days −13.5 + 54.3 vs. 11.2 + 18.8, p = 0.003). Conclusion: Compared to the control group, there was a transient drop in GFR in the LRV group during the first week, which recovered in all patients with no long-term renal sequelae. Therefore, LRV harvest does not impact on long-term renal function.