POS-756 DELAYED GRAFT FUNCTION POST RENAL TRANSPLANTATION: URINE COLLECTION CAN BE THE CULPRIT!

Abstract

Renal transplantation is the optimal treatment for patients with renal failure. Delayed graft function (DGF) due to surgical complications used to be a major worry, however, improvement in techniques minimised this risk to less than 5%. Nevertheless, 2.5-30% of recipients can experience a perirenal collection mainly as a urinary leak or lymphocele, causing DGF. Imaging, alongside with fluid analysis, can lead to early diagnosis, treatment and graft survival. Case presentation: A 28-year-old recipient noted to have high drain volumes in day 2 and 3 post live related renal transplantation. Fluid was immensely high in creatinine with five times higher K level compared to plasma. Graft function plateaued. Patient was euvolemic and stable otherwise. Imaging revealed severe hydronephrosis with extraperitoneal leak. Haematoma, seroma, abscess and lymphocele excluded and CT urography demonstrated urine extravasation (picture 1). Outcome: A small urine leak can be successfully managed conservatively in approximately 60% of patients, with maximal release of tension and urine diversion, to allow healing of the leaking. In the index case, high volume urine extravasation will need surgical intervention and restoration of the ureteric continuity (table 2). Urinary leak presents the most common urological complication in early post transplantation period and can result in DGF due to mechanical issues, hypovolemia and sepsis. Biochemical analysis of fluid and comparison to serum is essential to differentiate from lymphocele, hematoma or abscess. Imaging is a key point to confirm, diagnose collection and determine severity and location. Organ harvesting should be meticulous to avoid damaging ureter and vessels. Implantation should be tension free. DJ stenting has been promising in reducing incidence of urine leak, therefore, it should be routinely used and removed 6 weeks postoperatively.