Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years

Abstract

Introduction: This study is a retrospective analysis of ureteral complications and their management from a monocenter series of 277 consecutive renal transplantations. Materials and Methods: From September 1979 to June 1999, 277 renal transplantations (cadaveric origin) were performed in 241 patients. The ureter from the kidney graft was inserted into the bladder according to the technique of extravesical implantation described by Lich-Gregoir and Campos-Freire. The study analyzed the time of occurrence and the type of complications observed. The different procedures to restore the transplanted urinary tract are presented. Results: Complications occurred in 43/277 renal transplantations (15.5%). Anastomotic urine leakage or ureteral stricture were the most frequent. The time to appearance of these complications was either short (<1 month) or late (>1 month) in a similar number of cases. Most cases were managed surgically: 33/43 cases (76.7%). The most frequent surgical repair was ureterovesical reimplantation (n = 13), followed by: ureteroureteral end-to-end anastomosis (native ureter–ureter transplant, n = 5); pyeloureteral anastomosis (native ureter–renal pelvis transplant, n = 5); simple revision of ureterovesical implantation (n = 4); resection and end-to-end anastomosis of the transplant ureter (n = 2); calico-vesicostomy (graft-bladder, n = 1); implantation according to Boari (n = 1); pyelovesicostomy with bipartition of bladder (n = 1), and pyeloileocystoplasty with detubularized ileal graft (n = 1). No deaths related to any of the urological complications were reported. However, 2 consecutive vesico-renal refluxes led to the loss of the kidney graft in the long-term. Conclusion: The rate of complications observed in this retrospective analysis is similar to the experience of other studies, ranging from 2 to 20%. If the classical extravesical ureteral bladder implantation is to remain an attractive technique due to its simplicity, the surgical team at the training center should be aware of all the means to prevent any ureteral complications, such as the choice of another implantation technique and/or insertion of a transient ureteral stent.

Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections?

“…Opponents counter that the stent can migrate, could have bad permeability, could contribute to postoperative pain and stone formation [19,20]. Others advocate that stent can increase postoperative infection risk, can erode the lumen, can exacerbate long-term stricturing of the anastomosis and the use of stenting should be restricted to difficult ureterovesical anastomosis [21]. …”

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

“…Causing irreversible acute tubular necrosis, thrombotic complications are related with early graft failure (25,27). Early urinary complications such as ureteral necrosis and urinary leakage are seen at a rate of 4.6-8.7% in DDKTx patients (24,(28)(29)(30). Although they are usually complicated with urinary tract infections (31), graft and patient SR are not affected by surgically-treated urinary complications (30,32,33).…”

Outcome of Single Pediatric Deceased Donor Renal Transplantation to Adult Kidney Transplant Recipients

“…Complications rates did not differ either [18]. Overall, several studies found a higher complication rate for pediatric organs transplanted to an adult than in conventional DDRT [17,19,20,21,22]. The most common complications are vascular (venous thrombosis/arterial stenosis) or ureteral (stenosis/leakage) in nature.…”