Surgical Complications of Renal Transplantation

Abstract

In the early era of kidney transplant, surgical complications were a major cause of graft loss. Between 1960 and 1980, the estimated incidence was around 20%. With the improvement of surgical techniques, the frequency of these complications has dropped significantly and this subject until then common in the medical literature came to be seldom discussed (Botto V, 1993; Hernandez D, 2006). Currently, it is estimated that in large transplant centers the incidence of surgical complications is less than 5%. In general, the results of renal transplantation have improved primarily as a consequence of advances in medical and immunosuppressive therapy and progress in surgical techniques. Posttransplant urologic complications are unusual, with the range of 2.5% to 27% in most series, and can cause significant morbidity and mortality (Zargar MA, 2005; Dalgic A, 2006) Results have improved over the past decade as a direct application of less invasive endourologic diagnostic and therapeutic techniques of the surgical complications (Streem SS, 1994). However, the etiologies are the most common technical problems and association with immunological complications. Surgical complications after renal transplantation can be classified mainly as vascular (arterial and venous thrombosis, renal arterial stenosis, lymphocele, hemorrhage) and urologic (ureteral obstruction, vesicoureteral reflux, urinary fistula), although other types of complications are not uncommon, like graft’s rupture and hematoma. These complications can occur early in the intra-operative, immediate postoperative period or later, and imply in increase morbidity, hospitalization and costs (Humar A, 2005). Urologic complications are the most common surgical complication after renal transplantation, causing significant morbidity and mortality. Recently, the incidence of urologic complications after renal transplantation has decreased to 2.5% to 12.5% (Emiroglu R, 2001). Unfortunately, there is a still higher incidence of technical complications in pediatric recipients, reaching approximately 20% with an associated 58% and 74% graft survival rates for cadaveric and living-related transplantation (Salvatierra O Jr, 1997; US Renal Data System, 1996). Urologic complications represent an important cause of morbidity, delaying normal graft functioning, and in some cases leading graft loss and/or patient death (Beyga ZT, 1998; Colfry AJ Jr, 1974; Mundy AR, 1981; Hakim NS, 1994).