<p>Risk Factors for Anastomosis Leakage After Kidney Transplantation</p>

Abstract

Purpose Kidney transplantation is one of the best treatment options for end-stage renal disease with an incidence of urologic complications of 2.5 to 30%. One of the most serious and frequent urological complications is urinary leakage from ureteroneocystostomy anastomosis. The purpose of this study was to evaluate risk factors of urinary leakage from ureteroneocystostomy anastomosis after kidney transplantation. Patients and Methods A retrospective study was performed on patients who received kidney transplantation and were diagnosed with urinary leakage thereafter based on renal scan or drain creatinine per serum creatinine compared with patients in control group. Risk factor assessment was based on inpatient and outpatient information from hospital database. Results From 459 patients who received kidney transplantation in 2016–2018, there were 20 patients who were diagnosed with urinary leakage after they underwent ureteroneocystostomy anastomosis. The significant risk factors for anastomosis leakage were size of suture materials and duration of ureteral stent insertion. No statistically significant difference in other factors such as underlying disease, surgical technique or duration of urinary catheter was found. About overall urological complication, gender and body mass index significantly affected the outcome. Conclusion The rate of urinary leakage complications was found to be about 4.36%. The risk factors of overall complication comprised gender and body mass index. Although a lot of previous studies revealed many risk factors that could affect urinary leakage, size of suture materials and duration of ureteral stent insertion were the significant risk factors in our study. Proper consideration should be given to the size of suture materials and optimal duration of ureteral stent.

Ureteral Stenosis and Fistula after Kidney Transplantation

“…Ureteral complications are the most frequently reported urological complications after kidney transplantations. In our series of 648 patients, we observe an incidence of 5.4% (3.24% stenosis and 2.16% fistulas), which is lower than recently published series which report 6.2–8.2% [4, 11, 12] of stenosis and 4.8–8.5% [13, 14] of fistulas.…”

Intraoperative assessment of ureter perfusion after revascularization of transplanted kidneys using intravenous indocyanine green fluorescence imaging

“…The incidence of urinary leakage following KT in our hospital was reported as 4.4% (6). This complication is associated with significant morbidity (including prolonged hospital stay and graft loss) and mortality.…”

“…One of the most common urologic complications following KT is ureter anastomosis leakage, which leads to high morbidity along with kidney graft loss. At Ramathibodi Hospital, the incidence of urinary leakage complications was reported as roughly 4.4% (6). Compromising blood supply to the distal ureter during organ procurement is the primary risk factor for ureteral necrosis and urinary leakage, and can lead to high morbidity and kidney graft loss (7,8).…”

Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green

“…The two most common subtypes of ureterovesical anastomosis complications are stenosis/stricture/obstruction and urinary leakage/fistula [ 25 ]. Stenosis occurs in about 3% [ 4 , 18 , 25 , 26 ] and leakage/fistula in 1–4% [ 4 , 20 , 24 , 25 , 28 ]. Management strategies are similar for all subtypes and include mainly ureteric stenting, but also surgical revision [ 29 , 30 , 31 ].…”

“…As shown before, spending a long time on dialysis can lead to bladder atrophy, which increases the risk for ureterovesical anastomosis complications [ 18 , 38 ]. Further risk factors for general postoperative urological complications after kidney transplantation that have been identified in large retrospective case series include male recipient gender [ 21 , 26 , 27 , 33 ], technical aspects [ 1 , 4 , 27 , 28 ], cold ischemia time [ 18 ], extended criteria donors [ 39 ], donor age, and delayed graft function [ 40 ]. In contrast to other studies [ 33 , 41 , 42 ], arterial multiplicity did not influence the development of ureterovesical anastomosis complications in our patient cohort, but this is most likely due to the limited number of patients expressing this feature here.…”