Ureteral Complications of Pediatric Renal Transplantation

Morrison, Christopher; Shannon, Rachel; Rosoklija, Ilina; Nettey, Oluwarotimi; Superina, Riccardo; Cheng, Earl Y.; Gong, Edward M.

doi:10.1016/j.juro.2018.08.082

Cited by 11 publications

(30 citation statements)

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“…Ureteral complications requiring surgical revision were observed in only 3.6% of the cases. Of note, vesicoureteral reflux which has been identified as the most common ureteral complication was not evaluated in the immediate postoperative course, possibly explaining the comparatively low rate of urological complications in our cohort 16,42,43 . In contrast to previous reports, the type of urinary reconstruction did not influence the incidence of postoperative complications 44 .…”

Section: Discussioncontrasting

confidence: 61%

“…Previous publications emphasized increased rates of urological and vascular complications after pediatric KTx, especially in case of pediatric donors; however, recent data on incidence and risk factors as well as the effects of such complications in larger patient series are scarce since most studies focus on long‐term outcomes and immunological issues 9,10,15,16 …”

Section: Discussionmentioning

confidence: 99%

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Surgical complications in pediatric kidney transplantation—Incidence, risk factors, and effects on graft survival: A retrospective single‐center study

Beetz

Weigle

Nogly

et al. 2020

Pediatric Transplantation

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The field of pediatric kidney transplantation remains challenging due to an ongoing lack of size‐matched grafts and anatomical peculiarities. In the current study, we investigated the incidence of surgical complications in pediatric recipients, with a focus on risk factors and effects on graft outcome. We retrospectively reviewed all 2386 kidney transplantations at our institution from January 2005 until December 2018. Of these, 221 transplants were performed in pediatric recipients, defined as under the age of 18 years. Donor‐recipient body surface area ratios were calculated to evaluate the effects of size mismatching. Regression analyses were performed to identify independent risk factors for surgical complications and graft survival, respectively. Perioperative surgical complications requiring revision were observed in 34 (15.4%) cases. Leading cause for revision were vascular complications such as thrombosis or stenosis (n = 15 [6.8%]), which were significantly more frequent in case of young donors, (ie, donor age <6 years; OR: 4.281; CI‐95%:1.385‐13.226; P = .012), previous nephrectomy (OR: 3.407; CI‐95%:1.019‐11.387; P = .046), and en‐bloc grafts (OR: 4.923; CI‐95%:1.355‐17.884; P = .015), followed by postoperative hemorrhage (n = 10 [4.5%]), ureteral complications (n = 8 [3.6%]), and lymphoceles (n = 7 [3.2%]). Median follow‐up was 84.13 (0.92‐175.72) months. One‐, 5‐, and 10‐year graft survival rates were 97.1%, 88.9%, and 65.1%, respectively. Except for vascular complications (HR: 4.727; CI‐95%:1.363‐16.394; P = .014), none of the analyzed surgical morbidities significantly influenced graft survival. In conclusion, pediatric kidney transplantation achieves excellent long‐term results. However, meticulous surgical technique and continuous postoperative monitoring are imperative for early detection and treatment of imminent vascular complications, especially in case of young donors and en‐bloc grafts.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Surgical complications in pediatric kidney transplantation—Incidence, risk factors, and effects on graft survival: A retrospective single‐center study

Beetz

Weigle

Nogly

et al. 2020

Pediatric Transplantation

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“…5,16,17 The largest contemporary pediatric cohorts have reported rates of ureteral stricture from 5 to 8%. [6][7][8][9][11][12][13] We found a similar rate of post-transplant stricture requiring surgical intervention in 4% of patients. Diagnosis and management occurred at a median of 10 months after transplant.…”

Section: Ureteral Stricture and Stenosissupporting

confidence: 60%

“…At our institution, our surgeons attempt early but avoid ongoing endoscopic interventions, as we, like others, have not had success with this approach in management of stricture. 11 Similarly, Smith et al evaluated 526 renal transplants, of whom 42 (8%) developed ureteral obstruction. Children treated endoscopically underwent multiple treatments, including multiple stents or dilations, and many F I G U R E 2 Image of a ureteral stricture during retrograde ureterogram at the time of nephrostomy tube placement.…”

Section: Ureteral Stricture and Stenosismentioning

confidence: 99%

“…This approach has not been well described in the literature. 6,7,10,11,14,15 In this retrospective series, we evaluated pediatric patients who underwent renal transplantation and developed ureteral complications, requiring surgical intervention. We specifically aimed to describe the methodology of ureteral reconstruction based on patient characteristics.…”

Section: Introductionmentioning

confidence: 99%

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The utility of native ureter in the management of ureteral complications in children after renal transplantation

Serrell

O’Kelly

et al. 2021

Pediatric Transplantation

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Background: Ureteral complications after renal transplantation in children are a major source of morbidity. Management is complex and variable.Methods: With IRB approval, health records were retrospectively reviewed of patients who: were <18 years, underwent kidney transplant between 1997 and 2017, had at least 2 years of follow-up, and underwent interventions due to post-transplant ureteral complications.Results: Of 136 patients, seventeen (13%) required ureteral intervention due to stricture (n = 3), reflux (n = 12), or both (n = 2). Transplant occurred at median 10.5 years (3.1-14.7). Reconstruction occurred at median 10 months (7-15) after transplant.Pre-existing bladder pathology was present in 6 (35%) patients. Four of five patients with strictures had at least one endoscopic balloon dilation. Ultimate management included reimplantation, ureteroureterostomy of native to transplant ureter, pyeloureterostomy to native ureter, multiple endoscopic interventions followed by a Boari flap, or multiple failed endoscopic interventions. Fourteen patients with VUR underwent reimplantation (n = 5), ureteroureterostomy of native to transplant ureter (n = 4), pyeloureterostomy to native ureter (n = 4), and one underwent endoscopic injection with Deflux of the transplant ureter. Only one patient had a non-functioning graft due to ureteral complication. All patients were alive at follow-up (median 17 years [12][13][14][15][16][17][18][19]). Conclusions:Transplant ureteral reflux and stricture are significant complications following pediatric renal transplantation and may require surgical management. In our population, reflux or stricture requiring ureteral reconstruction occurred in 10% and 4%, respectively. Endoscopic interventions were rarely successful. Native ureters were used for ureteral reconstruction in more than two thirds of patients should be considered in management of ureteral complications.

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Renal Transplantation: Non-infectious Complications and Long-Term Outcome

Nguyen

Groothoff

2022

Pediatric Nephrology

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Ureteral Complications of Pediatric Renal Transplantation

Cited by 11 publications

References 0 publications

Surgical complications in pediatric kidney transplantation—Incidence, risk factors, and effects on graft survival: A retrospective single‐center study

Surgical complications in pediatric kidney transplantation—Incidence, risk factors, and effects on graft survival: A retrospective single‐center study

The utility of native ureter in the management of ureteral complications in children after renal transplantation

Renal Transplantation: Non-infectious Complications and Long-Term Outcome

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