Abstract
Background: Kidney transplantation with multiple renal arteries presents technical challen- {ges and elevates the risk of vascular complications. Objective is systematizing data on MRA, 'surgical approaches and evaluate the incidence and characteristics of associated vascular complications. Materials and Methods: A systematic review was performed using PubMed, Scopus, and Web of Science databases to analyze multiple renal arteries graft outcomes, reconstruction techniques, and postoperative complications. Results: Multiple renal arteries grafts can be successfully transplanted using various techniques, including back-table reconstruction, common ostium creation, side-by-side, or sequen tial anastomoses. Despite increased surgical complexity and prolonged ischemia time, multiple renal arteries grafts demonstrate patient and graft survival rates comparable to single artery grafts. Identified complications include renal artery/vein thrombosis, stenosis, pseudo- 'aneurysms, and arteriovenous fistulas. Early diagnosis via Doppler ultrasound or angiography remains crucial for graft preservation, Conclusion: Multiple renal arteries kidney transplantation is a feasible and effective procedure when utilizing appropriate reconstruction techniques. Meticulous planning and prompt 'complication detection are essential to optimize outcomes.