Factors Responsible for Urinary Fistula in the Renal Transplant Recipient

Hricko, George M.; Birtch, Alan G.; Bennett, Alan H.; Wilson, Richard E.

doi:10.1097/00000658-197311000-00010

Cited by 52 publications

(15 citation statements)

References 2 publications

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“…Ureteral complications are one of the most frequent issues encountered after kidney transplantation, in 2-26% of reported series [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. Ureteroneocystostomy is used routinely [13,14,15,16,17,24,25,30], ureteroureterostomy [19,20,22,34] and pyeloureterostomy [19] less frequently, and each technique has its pearls and pitfalls [29].…”

Section: Resultsmentioning

confidence: 99%

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Pseudorejection and True Rejection after Kidney Transplantation: Classification and Clinical Significance

Khater

Khauli²

2012

Urol Int

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Objectives: Multiple factors may result in an elevation in serum creatinine level after kidney transplantation, mimicking rejection. It is crucial to differentiate between a true rejection and other conditions inducing a ‘pseudorejection', in order to avoid overtreatment, or worse, mistreatment. Our goal was to review and classify true rejections and pseudorejections and their clinical significance. Material and Methods: This was a retrospective review of articles published in the USA and Europe, from 1976 to the present. The sites from which information was retrieved included PubMed, Clinical Imaging, Histopathology, Archives of Surgery, JACS, the American Urological Association, Medline and Springer Link. The importance of the resistive index will also be emphasized. Results: We reviewed 61 articles regarding the causes of renal graft dysfunction, which may be classified into true rejections and pseudorejections, the latter including the following 6 factors: hyperglycemia, ureteral obstruction, lymphocele, arterial stenosis, infection and recurrence of primary pathology. Conclusions: ‘Pseudorejection' has been described only once, for the first time in 1976 in the USA, and there have been no other reports since then. Multiple factors, mainly hyperglycemia, may induce a pseudorejection, presenting with an elevation of serum creatinine level and leading the clinician to an erroneous diagnosis of true rejection initially, resulting in inappropriate management.

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Section: Resultsmentioning

confidence: 99%

“…Ureteroneocystostomy is used routinely [13,14,15,16,17,24,25,30], ureteroureterostomy [19,20,22,34] and pyeloureterostomy [19] less frequently, and each technique has its pearls and pitfalls [29]. Most ureteral complications occur early in the postoperative course, and urinary fistula represents the most frequent one.…”

Section: Resultsmentioning

confidence: 99%

Pseudorejection and True Rejection after Kidney Transplantation: Classification and Clinical Significance

Khater

Khauli²

2012

Urol Int

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“…As a result, the orthotopic lumbar im 85 plantation of a third transplant, which can be theoretically seductive, practically imposes an ureteroureteric anasto mosis, the realization of which requires, however, an available ureter in the recipient and whose morbidity is characterized by frequent fistulous or anastomotic com plications [8,11,20,21,28,32].…”

Section: Discussionmentioning

confidence: 99%

“…In these specific conditions, and in the absence of comparable prior anastomosis, or, an exceptional case, in the presence of a duplicate excretory urinary tract, an ure teroureteric end-to-end anastomosis can be made. How ever, an available native ureter represents, despite the remarkable progress of endourological techniques, a po tential escape from complications of direct ureterovesical reimplantations which it is prudent to reserve for this not uncommon eventuality [9,10,20,21,25,27,28,30,32,34],…”

Section: Discussionmentioning

confidence: 99%

Serial Renal Transplant Surgery: Technical Reflections Concerning Third Transplants

et al. 1995

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From 1972 to 1993, we carried out 803 consecutive renal transplants including 8 third transplants. Exclusively cadaveric, these third renal transplants were implanted by intraperitoneal approach in right iliac position, without previous homolateral transplantectomy in 5 cases. The arterial anastomoses were common (7) or external iliac and hypogastric (1), and the venous anastomoses external (1) and common iliac (3), or inferior vena cava (4). Restoration of urinary continuity was by ureteronecystostomy (Politano-Leadbetter = 4, Grégoir-Lich = 3) or ureteroureteric anastomosis (1). The level of HLA compatibility varied from 2 to 5 identities (mean 3.1) and 4 of the 7 patients explored were hyperimmunized with lymphocytotoxic antibody levels > 80%. With the exception of the first of these third transplants, the immunosuppressive protocol associated azathioprine, prednisolone, antilymphocytic serum and cyclosporin. Postoperative sequels were marked by 3 vascular rejections and 1 death from hyperkalemia. Moreover, 1 urinary fistula on ureteroureteric anastomosis settled after percutaneous nephrostomy and placing of an uteric stent endoprosthesis. With a postoperative follow-up of 8-32 months (mean 24), 5 of the transplanted patients (62.5%) have a functional renal transplant with a serum creatinine from 120 to 180 µM/1 (mean 140). This brief series, whose failures are exclusively immunological, reveals the remarkable technical reliability for these third renal transplants in right iliac implantation, by median transabdominal approach and above a former transplant site.

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“…MacKinnon et al (27) (31 ). The most important cause of fistula and of obstruction, however, are disturbances of the ureteric blood supply (1,4,5,14,15,23,39,40). The ureter receives branches from the renal, internal spermatic or ovarian, hypogastric, rniddle haemorrhoidal, and superior and inferior vesical arteries.…”

Section: Discussionmentioning

confidence: 99%