Bilateral Native Ureteral Ligation Without Nephrectomy in the Management of Kidney Transplant Recipients With Native Proteinuria

Goh, Brian K. P.; Dean, Patrick G.; Cosio, Fernando G.; Gloor, James M.; Barrio, María Isabel Prieto; Stegall, Mark D.

doi:10.1111/j.1600-6143.2011.03721.x

Cited by 11 publications

(6 citation statements)

References 10 publications

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“…Alternatively, the native ureter may be ligated proximally with distal ureter swung to perform end‐to‐end anastomosis to the transplant ureter. Ligation of the native ureter in most cases is nonconsequential with atrophy of the native kidney in the long term . The authors suggest that the technique of uretrouretrostomy should be reserved for cases where a simple re‐implantation or a Boari flap reconstruction is not possible.…”

Section: Discussionmentioning

confidence: 99%

Ureteric reconstruction for the management of transplant ureteric stricture: a decade of experience from a single centre

et al. 2015

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SummaryThis study was conducted to review the outcomes of patients who had undergone surgical repair of a ureteric stricture following renal transplantation. All patients who developed a ureteric stricture and underwent ureteric reconstruction following renal transplantation, between December 2003 and November 2013, were reviewed. One thousand five hundred and sixty renal transplants were performed during the study period. Forty patients required surgical repair of a ureteric stricture (2.5%, 25 male, median age 48 ). The median time to stricture was 3 [1-149] months. 19 patients were reconstructed by reimplantation to the bladder, 18 utilized a Boari flap, two were a pre-existing ileal conduit and one was an anastomosis to a native ureter. In one patient, reconstruction was impossible and consequently an extra-anatomic stent was used. Two patients required re-operation for restricture and kinking. Median serum creatinine at 12 months following surgery was 148 [84-508] lmol/l. There was no 90-day mortality. Eleven grafts were lost at the time of this study, a median time of 11 [1-103] months after reconstruction. The incidence of ureteric stricture following renal transplant is low. Surgical reconstruction of the transplant ureter is the optimal treatment and is successful in the majority of patients.

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Section: Discussionmentioning

confidence: 99%

Ureteric reconstruction for the management of transplant ureteric stricture: a decade of experience from a single centre

et al. 2015

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“…However, a more recent, though retrospective, study carried out in 1036 renal transplant recipients observed from 1995 to 2007 found a strong association between renal cancer development after grafting and native renal cysts, with a 1.7-fold higher risk [33]. This underlines the importance of considering even a single native kidney cyst as a risk for malignant evolution after transplantation.…”

Section: Acquired Cystic Kidney Disease and Renal Cancermentioning

confidence: 82%

“…By using analytical modelling in a cohort of transplanted patients, Wong et al concluded that annual or biennial ultrasound screening achieves only a small gain in life expectancy, suggesting that it should be limited to patients at higher risk, such as those with acquired cystic diseases, a family history of renal cancer, or von Hippel-Lindau syndrome [54]. Goh et al, who observed a close relationship between native renal cysts and RCC development after transplantation [55], suggested initial screening within 1 month of grafting followed by a 2-yearly ultrasound examination in patients with even a single cyst, or 5-yearly in the remainder.…”

Section: Screening and Treatment Of Renal Cancer In Renal Transplant mentioning

confidence: 96%

Renal cancer in kidney transplanted patients

et al. 2015

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Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.

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“…It has been shown to be associated with minimal complications except for the need for nephrectomy later on primarily in patients with polycystic kidney disease as the underlying cause of renal dysfunction [ 9 ]. A retrospective study of 17 patients who underwent bilateral ureteral ablation did not show any evidence of post-operative pain or infection and was suggestive of short-term safety of the procedure [ 10 ]. Eighty-eight percent of the patients had underlying focal segmental glomerulosclerosis and 65% were not yet on dialysis.…”

Section: Discussionmentioning

confidence: 99%

Renal ablation using bilateral ureteral ligation for nephrotic syndrome due to renal amyloidosis

Keddis

Stegall

Textor

2012

Clinical Kidney Journal

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Nephrotic syndrome is common in immunoglobulin light chain amyloidosis (AL). In patients who do not achieve renal recovery, renal ablation has been reported for intractable proteinuria. We describe a patient with renal-limited AL who failed therapy and developed disabling proteinuria. He underwent laparoscopic ligation of the native ureters. Post-operatively, blood pressure improved. Hemodialysis was initiated. We conclude that bilateral ureteral ligation is a novel and minimally invasive method of renal ablation and may be considered for patients with refractory nephrotic syndrome.

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Bilateral Native Ureteral Ligation Without Nephrectomy in the Management of Kidney Transplant Recipients With Native Proteinuria

Cited by 11 publications

References 10 publications

Ureteric reconstruction for the management of transplant ureteric stricture: a decade of experience from a single centre

Ureteric reconstruction for the management of transplant ureteric stricture: a decade of experience from a single centre

Renal cancer in kidney transplanted patients

Renal ablation using bilateral ureteral ligation for nephrotic syndrome due to renal amyloidosis

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