Ureteral stenosis after kidney transplantation.

Abstract

Ureteral obstruction with impaired urine flow is the most common urological complication following renal transplantation. From December 3976 to December 1997,869 kidney grafts were performed by our kidney transplantation group, 96 from living related donors and 773 from cadaver donors (736 first grafts and 37 regrafts). A stricture of the ureter (SU) was observed in 27 cases with a follow-up ranging from 18 months to 18 years after the graft and 11 months to 11 years after the treatment of the SU. In six patients, SU was immediately apparent and limited to the anastomosis: they were obviously technical flaws. In all the other patients, there was a free interval ranging from 2 months to 11 years after surgery; the SU usually involved the entire ureter, suggesting multiple etiologies. Repeated urinary infections could be a cause but immunological problems might be more determinant. In our series, acute rejection was more common than chronic so that the correction of SU was followed in many cases by a good and long lasting result (up to 11 years). In our experience, SU was not a dangerous complication even in patients in whom for different reasons (mainly refusal of treatment) the therapy was delayedeven if anuria occurred, no case of graft loss or serious damage were observed. At the beginning of our experience, the diagnosis of SU was based on urography, and therapy has always been re-operation. For 15 years, the diagnosis of SU has been based on routine echographic surveillance, which was intensified after each rejection, and the first treatment of SU in the last 8 years was re-operation in early technical SU and interventional radiology (balloon dilatation with or without temporary stent) in other cases. When it failed or in case of recurrence, surgicai correction was performed utilizing the native ipsilateral or contralateral ureter for a ureteroureterostomy.

Classification of Ureteral Stenosis and Associated Strategy for Treatment After Kidney Transplant

“…Other risk factors include administering steroids, chronic rejection, and/or virus infection. 2,16,20,21 It has been observed that the features of presentation of US are associated with its causes. To perform prompt, effective treatment, we recommend the following 3 level classifications, based on the degree of US after a transplant.…”

The modified Barry technique to prevent vesicoureteric reflux in paediatric renal transplant recipients: Initial recipient outcomes

“…Ureteric obstruction occurring beyond the first postoperative month remains common (2e7.5%) [10,11] and mostly related to ureteral stenosis. In view of the risk of ischaemia to the distal ureter and subsequent risk of ureteric obstruction due to stenosis, we shortened the length of the tunnel.…”

Dual Kidney Transplant: Clinical Experience and Overview of Surgical Techniques

“…There was no urine leakage occurred in this series. In single kidney transplant, the incidence of urological complications was reported from 3.6 to 5.8 % [12][13][14].…”

“…One of the donors had high SCr (165 µmol/L) at the time of kidney procument. The incidence of DGF has been reported from 20% to 30% in dual kidney transplant [12,15]. The incidence of DGF may be attributed to longer CIT [16,17].…”