Lekehal B, Ait Youssef N, Lekehal M, Bakkali T, Jdar A, Bounssir A. Inferior epigastric artery cuff interposition for short renal artery in living-donor kidney transplantation: A case report and review of literature. World J Transplant 2025; 15(4): 109968 [DOI: 10.5500/wjt.v15.i4.109968]
Corresponding Author of This Article
Brahim Lekehal, MD, Chief, Chief Physician, DM, Full Professor, Lecturer, Professor, Department of Vascular Surgery, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Avenue des Nations Unis Agdal, B.P:8007.N.U., Rabat 6527, Rabat-Salé-Kénitra, Morocco. b.lekehal@um5r.ac.ma
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Transplantation
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 18, 2025
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World Journal of Transplantation
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2220-3230
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Lekehal B, Ait Youssef N, Lekehal M, Bakkali T, Jdar A, Bounssir A. Inferior epigastric artery cuff interposition for short renal artery in living-donor kidney transplantation: A case report and review of literature. World J Transplant 2025; 15(4): 109968 [DOI: 10.5500/wjt.v15.i4.109968]
World J Transplant. Dec 18, 2025; 15(4): 109968 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.109968
Inferior epigastric artery cuff interposition for short renal artery in living-donor kidney transplantation: A case report and review of literature
Brahim Lekehal, Noura Ait Youssef, Mehdi Lekehal, Tarik Bakkali, Asma Jdar, Ayoub Bounssir
Brahim Lekehal, Noura Ait Youssef, Asma Jdar, Ayoub Bounssir, Department of Vascular Surgery, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat 6527, Rabat-Salé-Kénitra, Morocco
Mehdi Lekehal, Department of Vascular Surgery, Centre Hospitalier Universitaire Ibn Sina, Rabat 6527, Rabat-Salé-Kénitra, Morocco
Tarik Bakkali, Department of Vascular Surgery, Mohammed V University, Rabat 6527, Rabat-Salé-Kénitra, Morocco
Co-corresponding authors: Brahim Lekehal and Noura Ait Youssef.
Author contributions: Lekehal B performed experiments and project administration; Ait Youssef N and Lekehal M wrote the first draft of the manuscript; collected the data; Ait Youssef N and Lekehal B are equally responsible for correspondence and revisions, and have played equally important role in leading the project, supervising the work, and writing the manuscript. Bounssir A, Bakkali T and Jdar A contributed to data interpretation and visualization; All authors reviewed, edited, and approved the final version of the manuscript.
Informed consent statement: Complete written informed consent was obtained from the patients (the donor and the recipient) for the publication of this study and accompanying images.
Conflict-of-interest statement: All the authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Brahim Lekehal, MD, Chief, Chief Physician, DM, Full Professor, Lecturer, Professor, Department of Vascular Surgery, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Avenue des Nations Unis Agdal, B.P:8007.N.U., Rabat 6527, Rabat-Salé-Kénitra, Morocco. b.lekehal@um5r.ac.ma
Received: May 30, 2025 Revised: June 14, 2025 Accepted: July 16, 2025 Published online: December 18, 2025 Processing time: 173 Days and 6.1 Hours
Abstract
BACKGROUND
Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors. However, anatomical challenges, such as a short renal artery, can complicate surgical procedures and increase complication risk, including thrombosis and anastomotic stenosis. To address these issues and optimize graft outcomes, innovative surgical techniques are essential.
CASE SUMMARY
We present a case of kidney transplantation complicated by a short donor renal artery. To address the discrepancy between arterial length and diameter mismatch, the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction. Following standard laparoscopic donor nephrectomy, vascular reconstruction was performed on the back table. The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery, enabling a tension-free anastomosis to the recipient’s external iliac artery. Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion. The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant. To our knowledge, this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction, offering a novel and effective technique for managing short renal arteries in kidney transplantation.
CONCLUSION
Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries, reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.
Core Tip: Due to the ongoing shortage of deceased donors, kidney transplantation has increased as a strategy to expand the donor pool. However, this rise has brought increased encounters. We report a successful transplantation involving a kidney with a short renal artery from a living donor, using inferior epigastric artery as a cuff interposition for arterial reconstruction. To our knowledge, this is the first documented case of using epigastric artery in this manner. This novel technique appears to be a promising solution to prevent early thrombosis caused by vessel size discrepancy, and mid- to long-term anastomotic stenosis due to myo-intimal hyperplasia.
