Percutaneous Management of Ureteral Obstructions and Leak After Renal Transplant.

Abstract

The aim of our study was to evaluate the safety and efficacy of percutaneous treatment of ureteral obstructions and leak after renal transplant and to evaluate the long-term results and graft survival rates in a single center. This retrospective study included 27 transplant recipients who received percutaneous treatment between January 2000 and December 2010 and who had follow-up data until December 2018. During this period, 294 renal transplants were performed at our institution, with 17 (5.7%) having a ureteral complication. Ten patients included in the study had their transplants at another center. Percutaneous nephrostomy, balloon dilatation, and double J stent placement were used in the management of complications. Cutting balloon dilatation and tandem ureteral stent placement were done in cases of resistant stenosis. Technical success and ureter patency rates were calculated. Graft survival rates were compared between early and late obstruction groups and between successful and unsuccessful interventional treatment. Among included cases, 21 obstructions (7 early, 13 late) and 8 leaks were detected. The technical success rate of percutaneous nephrostomy was 100% in all groups. The technical success rates of balloon dilatation and double J stent were 100% and 88% in the early and late obstruction groups, respectively. Censored graft survival rates in all groups at 1, 5, and 10 years were 89%, 89%, and 73.9%, respectively. In long-term follow-up, ureter patency rates were 100%, 33%, and 50% for early obstruction, late obstruction, and urinary leak groups, respectively (P = .018). Graft survival rates between early and late obstruction groups were not significantly different. No major complication, allograft loss, or 30-day mortality was seen. Percutaneous management of ureteral complications is safe and effective and should be considered as first-line treatment because of its less invasive nature and lower complication and morbidity rates.