End-to-Side Interrupted Versus Continuous Arterial Suturing in Living Donor Kidney Transplantation

This observational study evaluates whether different patterns of arterial suturing during kidney transplantation influence short-term graft function and vascular outcomes in adult living donor kidney recipients. The study compares interrupted versus continuous end-to-side arterial anastomosis to the iliac arteries using standardized surgical and postoperative care pathways. The research is designed as a combined retrospective and prospective non-randomized comparative cohort study conducted at the Assiut Kidney Transplantation Unit, Assiut University Urology Hospital. Adult patients who underwent or will undergo living donor kidney transplantation from November 2015 onward are assigned to one of two exposure groups based on the arterial suturing pattern chosen by the operating surgeon, without protocol-driven randomization. Preoperative assessment follows national kidney transplantation guidelines and includes detailed history, physical examination, laboratory investigations, and multimodal imaging of donors and recipients. Intraoperative management is standardized regarding donor nephrectomy technique, transplant approach, vascular anastomosis sites, ureteroneocystostomy, ischemia time recording, and immunosuppressive regimen. Postoperative follow-up extends for at least three months, with serial clinical evaluations, renal function tests, Doppler ultrasound, and radiologic imaging when indicated to detect vascular complications and characterize graft function trajectories over time. The primary goal is to determine whether one suturing pattern is associated with more favorable ischemia metrics and hemodynamic parameters, thereby informing best practice for vascular anastomosis in living donor kidney transplantation.