Kidney transplantation in patients with a urinary diversion

Abstract

Patients with congenital abnormalities of the lower urinary tract may develop end-stage renal failure, necessitating kidney transplantation. If their own bladder is unsuitable for implantation of the graft ureter, or if reconstructive surgery of the lower tract is not possible, the ureter can be implanted in an ileostomy or colostomy. The results of a follow-up study of 22 kidney transplants in 19 patients with a urinary diversion are reported. The immediate post-operative surgical complications were few, including one superficial wound abscess, one lymphocele, and one hematoma. One patient had a perforation of the ileal loop after the excision of an infected kidney. The late surgical complications involved excessive length of the ileal loop in two patients, nephrolithiasis in two, and ureteroileal anastomotic strictures in three. One patient died of liver failure 2 years posttransplantation with a well-functioning graft. Today, 16 of the remaining 18 patients have a well-functioning graft, one has impaired kidney function, and one is on dialysis. The 1- and 2-year graft survival rates are 90.6% and 74.7%, respectively, and the mean follow-up period is 5.5 years. Our results show that kidney transplantation in patients with a urinary diversion can be carried out with an acceptable complication rate and a very good patient and graft survival rate.