Abstract
Background: The implications of ligating the native ureter without ipsilateral nephrectomy after primary kidney transplant pyeloureterostomy (PU) have been described previously. Methods: This single-center retrospective cohort study including 4,215 kidney transplants performed between February 2010 and December 2014, analyzed urological complications following primary (P-PU) and secondary (S-PU) pyeloureterostomy used to treat urological leaks (UL-PU) and ureteral stenosis (US-PU) without concomitant ipsilateral nephrectomy, in a large cohort of patients. Results: There were 495 (11.7%) pyeloureterostomy with native ureter ligation without nephrectomy, 409 P-PU (82.6%) and 86 S-PU (17.4%), of which 76 were UL-PU and 10 were US-PU. The median follow-up was 33.8 months. The incidence of native ipsilateral kidney complications requiring nephrectomy was 2.02% (n = 10). Urinary leak was diagnosed in 3.6% of patients after P-UP and 9.2% after UL-PU. Ureteral stenosis was diagnosed in 1.7% of patients after P-UP, 3.9% after UL-PU and 10% after US-PU. Conclusion: This cohort analysis suggests that native ureter ligation during pyeloureterostomy without native nephrectomy is associated with low incidence of clinically indicated ipsilateral native nephrectomy. Caution and awareness should be emphasized in patients with history of ADPKD and neurogenic augmented bladders.
Highlights
Classical techniques for urinary tract reconstruction during a kidney transplant surgery include reimplantation of the kidney donor ureter with the recipients bladder or with the recipient’s native ureter
We evaluated the risk of future nephrectomy in these patients, and the secondary objective was to assess other urological complications with the need for surgical intervention
Isolated With skin dehiscence With surgical site infection With hematoma With internal hernia With skin dehiscence and surgical site infection Ureteral leak Isolated With hematoma With surgical site infection With aponeurosis dehiscence and hematoma With aponeurosis dehiscence and surgical site infection Perigraft hematoma Surgical site infection Ureteral stenosis Isolated With aponeurosis dehiscence With lymphocele and incisional hernia Venous thrombosis Skin dehiscence Lymphocele Incisional hernia Arterial thrombosis Renal rupture Ureteral leak treated with pyeloureterostomy (UL-PU) Total, n (%) Urinary leak Isolated With skin dehiscence With aponeurosis dehiscence Ureteral stenosis Surgical site infection Skin dehiscence Aponeurosis dehiscence Lymphocele Ureteral stenosis treated with pyeloureterostomy (US-PU) Total of complication Ureteral restenosis n = 409
Summary
Classical techniques for urinary tract reconstruction during a kidney transplant surgery include reimplantation of the kidney donor ureter with the recipients bladder (ureteroneocystostomy) or with the recipient’s native ureter (pyeloureterostomy or ureteroureterostomy). While both techniques show similar urological complication rates, most transplant centers initially opt for a ureteroneocystostomy using the Lich-Gregoir technique [1,2,3], deferring the use of ureteroureterostomy, usually without ipsilateral nephrectomy, as a secondary option in case of complications in the ureteroneocystostomy. CKD etiology Undetermined Hypertension Diabetes Mellitus Glomerulopathy ADPKD Neurogenic bladder Other. The implications of ligating the native ureter without ipsilateral nephrectomy after primary kidney transplant pyeloureterostomy (PU) have been described previously
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Schedule a callMore From: Transplant international : official journal of the European Society for Organ Transplantation
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