MP52-19 URETEROVESICAL LEAK REQUIRING INTERVENTION FOLLOWING RENAL TRANSPLANTATION: THE ROLE OF ACUTE REJECTION AND ANTI-REJECTION THERAPY - A SINGLE INSTITUTION NESTED CASE-CONTROL ANALYSIS AND SURVIVAL OUTCOMES OF 790 CONSECUTIVE RENAL TRANSPLANT RECIPIENTS

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP52)1 Apr 2020MP52-19 URETEROVESICAL LEAK REQUIRING INTERVENTION FOLLOWING RENAL TRANSPLANTATION: THE ROLE OF ACUTE REJECTION AND ANTI-REJECTION THERAPY - A SINGLE INSTITUTION NESTED CASE-CONTROL ANALYSIS AND SURVIVAL OUTCOMES OF 790 CONSECUTIVE RENAL TRANSPLANT RECIPIENTS Aneesh Srivastava*, Anil Mani, Uday Pratap Singh, M S Ansari, Rakesh Kapoor, and Sanjay Sureka Aneesh Srivastava*Aneesh Srivastava* More articles by this author , Anil ManiAnil Mani More articles by this author , Uday Pratap SinghUday Pratap Singh More articles by this author , M S AnsariM S Ansari More articles by this author , Rakesh KapoorRakesh Kapoor More articles by this author , and Sanjay SurekaSanjay Sureka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000914.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We assessed the predictors for ureterovesical leak and survival outcomes in a group of recently operated renal transplant recipients. METHODS: Recipients who underwent renal transplantation between January 2012 to May 2019 were retrospectively analyzed and studied in a nested case control design. All donor nephrectomies were done by experienced urologists taking special care to preserve the golden triangle. The recipient surgeries were also done by experienced surgeons and the anastomoses were done using stented extravesical tunneled Lich- Gregoire technique. Twelve cases of ureterovesical leak were identified and compared with 48 controls with respect to various factors which may have predicted leak; along with recording of patient and graft survival outcomes. RESULTS: Twelve out of 790 (1.5%) patients presented with ureterovesical leak in the postoperative period requiring intervention. Variables like gender, basic disease, diabetic status, previous transplantation, choice of induction immunosuppression, urine output and duration on hemodialysis were comparable between the groups. Factors such as acute rejection, ABO incompatibility, complete HLA mismatch, older age and plasmapheresis were found to be significant in univariate analysis. Plasmapheresis therapy, complete HLA mismatch and older age were significant in multivariate analysis. Plasmapheresis demonstrated highest risk of leak. Patient survival was also considerably reduced in the leak group but the graft survival was comparable. None of the patients required surgical intervention as leak resolved in all these patients by conservative therapy. CONCLUSIONS: Acute rejection and anti-rejection therapy; specifically, heavy immunosuppression using plasmapheresis and IV immunoglobulins might have significant association with ureteric leak. The survival outcomes showed significant reduction in the patients’ overall survival with ureteric leak; however, the graft survival outcomes were comparable. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e779-e780 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aneesh Srivastava* More articles by this author Anil Mani More articles by this author Uday Pratap Singh More articles by this author M S Ansari More articles by this author Rakesh Kapoor More articles by this author Sanjay Sureka More articles by this author Expand All Advertisement PDF downloadLoading ...