Stone‐bearing live‐donor kidneys for transplantation

Abstract

OBJECTIVE To evaluate potential donor kidneys with asymptomatic calculi detected during screening, and the management of the calculus before, during and after transplantation, as with fewer live donors, marginal kidneys and donors are a significant subgroup in renal transplantation. PATIENTS AND METHODS Five live‐related donors, with one incidentally detected calculus during their routine evaluation, were accepted for transplantation. Of these, three were detected only on spiral computed angiography. There was no biochemical evidence of a metabolic abnormality or history of stone disease. One donor had elective lithotripsy and another nephrolithotomy under ultrasonographic control immediately after perfusion. The others were transplanted with the calculus in situ. Ureteric reimplantation was by the Leadbetter‐Politano technique over a JJ stent. RESULTS One recipient patient passed the calculus within 4 h of stent removal. The follow‐up ultrasonogram at 3 months showed a stone in only one recipient. In the others, the calculus could not be seen after stent removal. The maximum follow‐up was 2 years and graft function has remained normal in all. CONCLUSIONS Voluntary kidney donors with one calculus incidentally detected on routine evaluation form a unique group and can be accepted for transplantation in selected cases. Careful follow‐up of the donor and recipient is essential, with early intervention if necessary.

Endourological management of live donors with urolithiasis at the time of donor nephrectomy: a single center experience

“…There are few case series which have shown that the short-and medium-term results are excellent both in donor and recipient follow-up after bench ureteroscopy [12][13][14][15][16][17][18]. We need long-term results with large number of patients to establish bench URS/RIRS as treatment of choice for this specific category of patients.…”

Kidney Laterality and the Safety of Hand-assisted Live Donor Nephrectomy: Review of 1000 Consecutive Cases at a Single Center

“…19 A smaller right kidney and undiagnosed lesions within the right donor kidney were also indications for right donor nephrectomy. 20 In our series, if the relative function is lower, and if there is a renal cyst or tiny stone (<5 mm) in the right kidney, the right kidney was removed to benefit the donor. A retrospective study of 25 living donor kidneys with cysts found no cystrelated complications in transplanted organs, 21 similar to the results in our series.…”

Ex-VivoUreteroscopy at the Time of Live Donor Nephrectomy

“…Stone-free rates have ranged from *60% to 100% for stones < 4 mm in small series with < 2 years mean follow-up. 4,5 Conversely, Klingler and colleagues 6 noted the development of ureteral obstruction after transplantation of stone-containing kidneys in 4/5 patients necessitating nephrostomy tube placement, including all patients with calculi > 4 mm. 6 Endoscopic extraction immediately after donor nephrectomy is another option that has been previously described with minimal risk of recurrence.…”