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21 May 2009

Treatment of urinary complications after kidney transplantation

A Chmura, W Rowiński, J Wałaszewski, M Czaplicki, J Trzebicki, A Kwiatkowski

Ann Transplant 2009; 14(1): 52-53 :: ID: 880391


Background: Urinary complications after kidney transplantation can lead to the graft loss. We present different methods of treatment in diverse clinical situations.
Material/Methods: In the period of 1982-2008 we have transplanted 1500
kidneys in our Department, including 70 living related (5%). In this period 103 patients with urinary complications were treated (68 patients transplanted in our department and 35 referred from other transplant centres). In 63 patients complications occurred within 30 days post transplantation, in remaining 40- complications developed later on. Following urinary complications have been observed:
1. Early: • Urinary fistula 30; • Necrosis of the ureter 21; • Stricture of the urinary anastomosis 10; • Urinary anastomosis to the peritoneum 2; • Thrombus in kidney's pelvis and the ureter 1.
2. Late: • Stricture of the urinary anastomosis 39.
Methods: The following treatment was performed: • Uretero-vesical re-anastomosis; • Resection of the necrotic ureter and secondary anastomosis; • Resection of the ureter at the level of pelvis and anastomosis to the own ureter; • Reconstruction of the ureter with the Boari flop; • Ligation of the ureter and permanent nephrostomy; • Transcutaneous pyelostomy.
Results: In all but one cases good early and late results were obtained with
preservation of the function of transplanted kidney. In one fatal case the small arterial branch thrombosis resulted in necrosis of kidney's lower pool and massive ureter and pelvis necrosis. Patient lost the graft. In all other cases good technical and clinical result of performed surgery has been obtained.
Conclusions: Treatment of the urinary complications after renal transplantation requires surgical and urological experience of the operating team. Definite treatment should be intended during reconstructive surgery, since consecutive operations lead to a higher risk of a graft failure.

Keywords: Kidney Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358