Surgical management of early and late ureteral complications after renal transplantation: Techniques and outcomes
Renal transplantation; Ureteral complications; Ureteral leak; Ureteral revision; Ureteral stenosis
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Background: In this study, we present our experience with ureteral complications requiring revision surgery after renal transplantation and compare our results to a matched control population. Methods: We performed a retrospective analysis of our database between 1997 and 2012. We divided the cases into early (<60 d) and late repairs. Kaplan-Meier and Cox proportional hazards models were used to compare graft survival between the intervention cohort and controls generated from the Scientific Registry of Transplant Recipients data set. Results: Of 2671 kidney transplantations, 51 patients were identified as to having undergone 53 ureteral revision procedures; 43.4% of cases were performed within 60 d of the transplant and were all associated with urinary leaks, and 49% demonstrated ureteral stenosis. Reflux allograft pyelonephritis and ureterolithiasis were each the indication for intervention in 3.8%; 15.1% of the lesions were located at the anastomotic site, 37.7% in the distal segment, 7.5% in the middle segment, 5.7% proximal ureter, and 15.1% had a long segmental stenosis. In 18.9%, the location was not specified. Techniques used included ureterocystostomy (30.2%), ureteroureterostomy (34%), ureteropyelostomy (30.1%), pyeloileostomy (1.9%), and ureteroileostomy (3.8%). No difference in overall graft survival (HR 1.24 95% CI 0.33-4.64, p = 0.7) was detected when compared to the matched control group. Conclusion: Using a variety of techniques designed to re-establish effective urinary flow, we have been able to salvage a high percentage of these allografts. When performed by an experienced team, a ureteric complication does not significantly impact graft survival or function as compared to a matched control group.
Berli, J., Montgomery, J., Segev, D., Ratner, L., Maley, W., Cooper, M., Melancon, J., Burdick, J., Desai, N., Dagher, N., Lonze, B., Nazarian, S., & Montgomery, R. (2015). Surgical management of early and late ureteral complications after renal transplantation: Techniques and outcomes. Clinical Transplantation, 29 (1). http://dx.doi.org/10.1111/ctr.12478