An Update on Early Urological Complications in Kidney Transplantation: A National Cohort Study

Abstract

BackgroundThis study aimed to provide an update on the occurrence of early urological complications in living-donor and deceased-donor kidney transplantation (KTX).Material/MethodsData on all kidney transplant recipients in the Netherlands between January 2005 and December 2015 were retrieved from the prospectively collected Dutch National Organ Transplant Registry Database (NOTR). We assessed the incidence of major urological complications (MUCs) within 3 months after KTX, defined as urinary leakage and ureteral obstruction. Outcomes of living donor and deceased donor kidney transplants were compared. We performed regression analysis to identify predictive factors of urological complications and studied the influence of early urological complications on graft and patient survival. We performed an additional sub-study to explore the influence of preservation of the peri-ureteric connective tissue in living-donor KTX on the occurrence of urological complications.ResultsAmong 3329 kidney transplant recipients, urological complications occurred in 208 patients (6.2%) within 3 months after surgery. There were no significant differences in complication rates between recipients from living donors and deceased donors. Multiple regression analysis showed that older donor age and previous cardiac events of the recipient were predictors for the development of urological complications. Graft and patient survival were not affected by early MUCs. The additional sub-study showed that preservation of peri-ureteric tissue within living-donor KTX was not independently associated with urological complications.ConclusionsMany living- and deceased-donor KTX recipients have early urological complications. MUCs did not affect long-term graft or patient survival.

Urological Complications in Kidney Transplant Recipients: Analysis of the Risk Factors and Impact on Transplant Outcomes in the Era of “Extended Criteria Donors”

“…In our analysis, UC occurred in 7% of cases after KT, mainly represented by urinary strictures. The UC rate of our population is in line with these reported by other recent studies [2,34]. Arpali E et al in 2018 described that UCs were observed in 9.3% of 2274 patients undergoing KT [2].…”

“…Arpali E et al in 2018 described that UCs were observed in 9.3% of 2274 patients undergoing KT [2]. Moreover, in 2019 a national registry study from the Netherlands reported that, among 3329 KT recipients, UCs were developed in 208 (6.2%) of patients within 3 months after surgery [34]. Compared to an older cohort [24,25,35,36], the reduced incidence of UC observed in the last decade could be related to many factors, but advances in surgical techniques have most probably had a major effect.…”

Hand-Assisted Laparoscopic Donor Nephrectomy in Living Donors with a History of Abdominal Surgery: A Retrospective Cohort Study

“…Many articles have referred to the incidence of urinary complications (1.0–9.2%) after kidney transplantation [ 17 – 21 ]. Common causes of urinary complications were vascularity of the donor ureter and the surgical technique.…”

Recipient and renal allograft survival following living related-donor transplantation: a single center experience

“…[10] Our findings are in concordance with those of van Roijen et al, who documented that surgical intervention of urological complications during the early post-operative period did not affect patient or graft survival. [11] It has been previously documented by Bruintjes et al [12] and Faenza et al [13] that there is no relationship between the type of urinary anastomosis and the risk for surgical urological complications. The success of ureterovesical anastomosis depends on the vascularity of the donor ureter, which may be compromised during the donor nephrectomy and by handling during transplantation.…”