Urological Complications: Analysis and Management of 1525 Consecutive Renal Transplantations

• Published in: Transplantation proceedings Vol. 40; no. 5; pp. 1386 - 1390
• Main Authors: Zavos, G, Pappas, P, Karatzas, T, Karidis, N.P, Bokos, J, Stravodimos, K, Theodoropoulou, E, Boletis, J, Kostakis, A
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2008; Elsevier Science
• Subjects: Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Greece; Humans; Kidney Transplantation - adverse effects; Living Donors; Male; Medical sciences; Retrospective Studies; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Ureteral Obstruction - epidemiology; Ureteral Obstruction - surgery; Urologic Diseases - epidemiology; Urologic Diseases - surgery; Greece; Medicine; Clinical management; Treatment; Urinary system; Surgery; Analysis; Complication; Graft; Homotransplantation; Kidney; Kidney transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.03.103

Abstract Urological complications after renal transplantation increase morbidity, delay graft function, and occasionally lead to graft and/or patient loss. The aim of this study was to analyze the causes of and therapeutic approaches to urological complications in renal transplantation as they related to patient outcomes. A series of 1525 consecutive renal transplantations were performed over a 24-year period. Renal grafts were obtained in 814 cases from living-related and in 711 from cadaveric donors. A Lich-Gregoire ureterovesical reimplantation technique with minimal bladder wall dissection was employed in all cases. Ureteral stents were routinely used in cadaveric transplants and exceptionally among living-related grafts. Urological complications were classified according to the mechanism and site of urinary tract involvement: graft ureteropelvic junction obstruction/stenosis (A), ureteral obstruction/stenosis (B), ureterovesical anastomosis obstruction/stenosis (C), urinary leakage (D), and other (E). Overall, we encountered 96 urological complications (6.3%). Group C complications occurred in 29 cases (30.2%), followed by 27 cases (28.1%) for group B patients, 25 cases (26.0%) for group D, 12 cases (12.5%) for group A, and 3 cases (3.1%) for group E patients. Surgical intervention was required in 49 (51.0%) of all urological complications. The others (n = 47, 49.0%) were treated either conservatively or by minimally invasive procedures. A rapid diagnosis of urological complications, assisted by early posttransplant DTPA scans, routine ultrasonography, and especially prompt treatment, resulted in compensation of renal graft dysfunction in the vast majority (n = 90, 93.8%) of cases. Surgical techniques of graft retrieval and reimplantation are of utmost importance to minimize the incidence of urological complications.