Common Versus External Iliac Arterial Anastomosis in Kidney Transplantation: A Bicentric Retrospective Analysis of Vascular Complications and Graft Outcomes.

BACKGROUND Vascular complications remain a significant concern after kidney transplantation. While external iliac (EI) implantation is standard, common iliac (CI) implantation is occasionally performed in selected cases, particularly in the presence of vascular disease or anatomical constraints. We compared vascular outcomes according to the arterial anastomosis site. MATERIAL AND METHODS We conducted a bicentric retrospective study including kidney transplant recipients between 2015 and 2019. Implantation strategy differed between centers, with a preferential use of CI implantation in one center and EI implantation in the other. Patients underwent arterial anastomosis to the CI (n=157) or EI vessels (n=359). The primary endpoint was vascular complications graded according to the Clavien-Dindo classification. Secondary endpoints included ≥60% vascular stenosis, lymphocele rate, and graft failure at 2 years. RESULTS Baseline characteristics differed between groups, reflecting center-specific practices and case-mix variations. Overall vascular complication rates were similar (22.9% in CI vs 20.1% in EI; P=0.46). However, Clavien-Dindo ≥III complications were more frequent in the CI group (14.6% vs 7.5%; P=0.01). Severe vascular stenosis requiring intervention (Clavien-Dindo III) occurred more often in CI recipients (7.0% vs 0.8%; P<0.01). Lymphocele was also significantly more frequent in the CI group (27.4% vs 9.2%; P<0.01; OR 4.55, 95% CI 2.56-8.09; P<0.001). At 2 years, graft failure rates did not differ significantly (4.1% vs 5.3%; P=0.29). CONCLUSIONS In this bicentric retrospective analysis, CI implantation was associated with a higher rate of severe vascular complications, particularly stenosis, and lymphocele, without a significant impact on graft failure at 2 years. These findings should be interpreted with caution, as they likely reflect, at least in part, differences in patient selection and center-specific surgical practices.