Efficacy of Interventional Radiology Procedures for the Treatment of Early Ureteral Complications After Kidney Transplantation

Abstract

Ureteral stricture and ureteral leakage are the most common early urological complications after kidney transplantation causing decreased urine output and increased serum creatinine and blood urea nitrogen. We report our experience with internal-external ureteral stent placement and ureteroplasty. Materials and Methods From August 1999 to January 2005, we treated nine patients presenting with stricture or leak. After an anterograde pyelogram, an internal-external nephrostomy catheter was inserted in all patients; in four patients we also performed ureteroplasty. Results The stricture and leak appeared from 12 to 93 days after kidney transplantation (mean = 39 ± 29 days). After a mean of 80 ± 43 days (range 25–141 days), the stent was successfully removed in seven patients (77%); no patient had a recurrence. The success was confirmed by a decline in serum creatinine (from 3.7 ± 1.4 to 1.6 ± 0.7 mg/dL) and blood urea nitrogen (from 54 ± 24 to 28 ± 7 mg/dL) with resolution of hydronephrosis on sonography. No procedure-related complications were observed. Surgical correction was necessary in two patients due to the persistence of a stricture. At long-term follow-up (50 ± 17 months), seven kidneys were still functioning and two had failed due to chronic rejection. Conclusion Nephrostomy catheter placement and ureteroplasty are safe, effective alternatives to surgery to treat early ureteral complications after kidney transplantation. Interventional radiology procedures reducing the morbidity and the likelihood of loss of graft function may improve graft and patient survival.