Evaluating the effect of incision and puncher arteriotomy methods on kidney transplant outcomes: a prospective comparative cohort study

Purpose Vascular anastomosis is a critical determinant of graft function and long-term survival in kidney transplantation. The choice of arteriotomy technique may influence hemodynamic flow and early graft outcomes. This prospective study aimed to compare functional and Doppler ultrasonographic outcomes between incision and puncher arteriotomy techniques in kidney transplant recipients. Methods A total of 54 adult kidney transplant recipients were prospectively enrolled and allocated into two groups according to arteriotomy technique: incision (n = 27) and puncher (n = 27). Patients were followed at 0–1 month, 3–6 months, and 6–12 months postoperatively. Renal function tests (creatinine, GFR) and Doppler ultrasonographic parameters, including resistive index (RI) and peak systolic velocity (PSV), were recorded and compared between groups and across time points. Results At the first postoperative month, mean serum creatinine levels were higher in the puncher group compared to the incision group (p = 0.046), while GFR values were similar (p > 0.05). During long-term follow-up (6–12 months), no significant differences were observed between groups in RI, PSV, or GFR (all p > 0.05). Serum creatinine levels remained higher in the puncher group across follow-up (p = 0.021). Peak systolic velocity ratio values at 6–12 months were comparable between groups (p > 0.05). Sex-based analysis revealed higher creatinine levels in male patients at all time points, whereas GFR values did not differ significantly by sex. Conclusions Incision and puncher arteriotomy techniques provide comparable long-term graft function and hemodynamic outcomes in kidney transplantation. When meticulous anastomosis is achieved, either technique may be safely selected based on surgeon preference and vascular anatomy.