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04/16/2026
A Rare Milestone in Kidney Transplantation Without ASCT
We recently managed a highly challenging and rare case of kidney transplantation in a patient with multiple myeloma who had not undergone an autologous stem cell transplant (ASCT)—a scenario with very limited precedent worldwide.
From a surgical standpoint, the case presented multiple complexities:
• The donor kidney had three renal arteries, each requiring separate anastomosis, increasing technical difficulty and operative precision.
• The recipient’s external iliac artery was tortuous, coursing medially to the external iliac vein—an unusual anatomy that posed challenges for vascular alignment.
• To achieve an optimal, tension-free configuration and avoid kinking, vascular transposition was performed, ensuring a satisfactory anatomical lie.
Despite these challenges, the outcome was encouraging. The patient remained stable both intraoperatively and postoperatively, with excellent perfusion across all arterial anastomoses.
This case highlights the importance of meticulous surgical planning, adaptability in complex anatomy, and a multidisciplinary approach in expanding the boundaries of transplant eligibility.
