PD25-09 RISK FACTORS FOR TECHNICAL FAILURE OF RENAL AUTOTRANSPLANT: RESULTS OF 103 CASES FROM A SINGLE INSTITUTION

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2018PD25-09 RISK FACTORS FOR TECHNICAL FAILURE OF RENAL AUTOTRANSPLANT: RESULTS OF 103 CASES FROM A SINGLE INSTITUTION Mohamed Eltemamy, Ahmed Elshafei, Rathika Ramkumar, Alvin Wee, Stuart Flechner, and Venkatesh Krishnamurthi Mohamed EltemamyMohamed Eltemamy More articles by this author , Ahmed ElshafeiAhmed Elshafei More articles by this author , Rathika RamkumarRathika Ramkumar More articles by this author , Alvin WeeAlvin Wee More articles by this author , Stuart FlechnerStuart Flechner More articles by this author , and Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1336AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal autotransplantation (RA) is an accepted therapeutic option for select indications. We sought to analyze factors associated with technical failure in RA patients. METHODS We reviewed 103 patients who underwent RA from 2004 to 2017. Satisfactory outcome (SO) was defined as post-operative patent vasculature on ultrasound and/ or normal nuclear scan. Unsatisfactory outcomes (UO) included Compromised grafts (CG) (partial infarction on radiographic studies more than 20%) and lost grafts (LG) (nephrectomy or absent perfusion on radiographic studies). RESULTS Median age was 39 years (IQR: 32-47). Females were 71 (69%) and males were 32 (31%). Median follow up time was 9.5 months (IQR: 2.5-30) Indications for RA were renovascular diseases (n=27), Ureteric pathology (n=30), intractable nephrolithiasis (n=30), flank pain (n= 15) and pancreatic neoplasm (n=1). 89 (86.4%) patients had a SO while 14 (13.6%) had a UO (CG= 7, LG= 7). There was no statistically significant difference between UO and SO in median preoperative creatinine (p=0.2), preoperative positive urine culture (p=0.32), history of stone disease (P=0.27) and prior urinary tract instrumentation (p=0.11). However, presence of ureteric stent or nephrostomy tube (PCN) at time of RA was significantly higher in UO (42.9% vs. 16.9%, p=0.04). Also, multiple arterial anastomoses were more frequent in UO (42.9% vs 18.2%, p=0.03). Other operative variables including median blood loss (p=0.23) and type of urinary reconstruction (p=0.6) were not significantly different. Median creatinine at last follow up was higher in UO compared to SO (1.08 mg/dl vs 0.86 mg/dl, p= 0.005). On logistic regression model, the presence of a stent or PCN at time of surgery (OR 4.19, 95% CI 1.2-14.71, p=0.03) and multiple arterial anastomoses (OR 3.89, 95 CI 1.11-13.63, p=0.03) were independent predictors of UO. CONCLUSIONS The presence of a stent or PCN at time of surgery and multiple arterial anastomoses were associated with graft compromise or loss. While the correlation between number of arteries and outcomes is sound, the stronger correlation of stents and PCN at time of surgery with worse outcomes is unclear. Our hypothesis is that ureteric stents and PCNs harbor infections despite appropriate antibiotic treatment. Consequently, these kidneys are more prone to technical failure after RA suggesting the need for an alternative approach with respect to those indwelling devices. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e549-e550 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mohamed Eltemamy More articles by this author Ahmed Elshafei More articles by this author Rathika Ramkumar More articles by this author Alvin Wee More articles by this author Stuart Flechner More articles by this author Venkatesh Krishnamurthi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...