Urological complications after living‐donor renal transplantation

El-Mekresh, Mohsen; Osman, Yasser; Ali-El-Dein, Bedeir; El-Diasty, Tarek; Ghoneim, Mohamed A.

doi:10.1046/j.1464-410x.2001.00113.x-1

Cited by 86 publications

(70 citation statements)

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“…11,12 The incidence of ureteral complications ranged from 3% to 14% among different transplant units. 1,[12][13][14][15] Ureteral stricture is more commonly encountered (3% to 8%) 1,5,16,17 than is urinary leakage (1.55%). 17 These 2 major complications can be promptly identified and repaired or corrected without compromising graft function in the long term.…”

Section: Discussionmentioning

confidence: 99%

“…Ureteral stenosis (US) is one of the most common urologic complications and has been reported in 2.6% to 15% of transplanted patients. [1][2][3][4][5][6][7][8][9] This wide range probably reflects differences in definitions of urologic complications after kidney transplant. Treatment for US ranges from a minimum interventional procedure to open surgical reconstruction of the urinary tract.…”

Section: Introductionmentioning

confidence: 99%

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

He¹,

Bremner²,

Han³

2013

Exp Clin Transplant

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Objectives: Ureteral stenosis is a common complication after a kidney transplant. Treatment for ureteral stenosis ranges from interventional procedures to open surgery. The aim of this study is to present classification for ureteral stenosis and recommend the targeted strategy for effective treatment. Materials and Methods: Twelve cases of ureteral stenosis were diagnosed among 193 kidney transplants, of which 91 were from a live donor and 102 from a deceased donor. The mean age was 46.22 ± 13.23 years. The diagnosis of ureteral stenosis includes serum creatinine elevation, hydronephrosis, and presence of stricture on a pyelogram. The criterion for classification is based on the severity of stricture. Results: One of ureteral stenoses was classified as grade 1, six were grade 2, and five were grade 3. Of 12 cases, 10 were live-donor kidney transplant, 4 had lymphocele, and 2 had a hematoma after transplant. The corresponding strategy for each grade of ureteral stenosis is as follows: grade 1, ureteral stent reinsertion; grade 2, cutting balloon dilatation or endoscopic incision of stenosis; grade 3, open surgery urinary tract reconstruction. All cases were successfully treated using these strategies.Conclusions: This classification of ureteral stenosis provides guidance for effective management and avoids unnecessary procedures. In this series, ureteral stenosis was significantly associated with a live donor and surgical complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

He¹,

Bremner²,

Han³

2013

Exp Clin Transplant

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“…Therefore, some authors suggest performing protocol biopsies at a defined time course after transplantation, irrespective of the status of graft function (8). As an invasive procedure, biopsy carries the risk of significant graft injury and is not feasible in patients taking anticoagulant medication (10,11). Moreover, the limited sampling sites (randomly chosen, and exceedingly small, portions of tissue) may lead to falsenegative results, such as when rejection is focal or patchy.…”

mentioning

confidence: 99%

Potential of Noninvasive Serial Assessment of Acute Renal Allograft Rejection by ¹⁸F-FDG PET to Monitor Treatment Efficiency

Reuter

Schnöckel²,

Edemir³

et al. 2010

J Nucl Med

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We propose 18 F-FDG PET as a method to monitor acute rejection of allogeneic renal transplants in a rat model. Methods: Allogeneically transplanted (aTX) rats (binephrectomized Lewisbrown Norway to Lewis) served as the renal transplant model. aTX rats treated with cyclosporine A (CSA) served as a therapy monitoring group. Healthy control rats, rats with acute CSA nephrotoxicity, rats with acute tubular necrosis, syngeneically transplanted (sTX) rats, and aTX rats treated with CSA since postoperative day 0 served as controls. After surgery, renal glucose metabolism was assessed in vivo serially up to postoperative day 7 by performing small-animal PET 3 h after intravenous injection of 30 MBq of 18 F-FDG. Mean radioactivity (cps/mm 3 of tissue) was measured and the percentage injected dose calculated. Results were confirmed by histologic, functional, and autoradiographic analysis. Results: Renal 18 F-FDG uptake was significantly elevated at postoperative day 4 in aTX rats, when compared with control, sTX, acute tubular necrosis, or CSA-treated rats (P , 0.05). In vivo 18 F-FDG uptake correlated with the results of autoradiography and with inflammatory infiltrates observed on histologic examination. Notably, 18 F-FDG PET assessed the response to therapy 48 h earlier than the time at which serum creatinine decreased and when histologic examination still showed signs of allograft rejection. In aTX rats, the CSA-susceptible graft infiltrate was dominated by activated cytotoxic T cells and monocytes/macrophages. Conclusion: 18 F-FDG PET is an option to noninvasively assess early response to therapy in rat renal allograft rejection.

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“…In our experience, it is learnt that gentle handling kidney graft, preservation of adequate periureteric tissue, ureter being shorten to a proper length are essential to prevent urological complication post kidney transplantation. LichGregoir technique has been preferred due to its advantages over other techniques [11]. In the modification, one additional suture is placed at the each side of proximal part of the incised muscular layer of bladder to seal the potential gap surrounding the ureter, where the ureter enters to the bladder.…”

Section: Discussionmentioning

confidence: 99%

Preventable Urological Complications Post Kidney Transplant with Modified Lich-Gregoir Technique for Ureteroneocystostomy

He¹,

Ng²

2016

J Transplant Technol Res

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Aim: Various ureteroneocystostomy techniques for kidney transplant have been described with Lich-Gregoir (LG) being widely employed. However, even with multiple modifications on this technique, urine leakage and ureteric stenosis remain as most common complications. This study aims to evaluate urological complications by using our modified LG technique after kidney transplant. Method: From 26th January 2010 to 30 th May 2014, 206 consecutive kidney transplants were performed at our institute. 124 were deceased-donor and 69 were live-donor kidney transplants; 13 patients received a small tumour excised kidney graft. All transplants except one were done by conventional open surgery. The modification involves an additional stitch placed at proximal part of bladder muscular incision with peri ureteric tissue at the entrance of ureter to bladder. Urological complications were defined as urine leakage or ureteral stricture. The patients were followed-up from 12 to 64 months. Results:There was no urine leakage in this cohort. One case of ipsilateral dual-kidney transplant developed distal ureteral stricture secondary to a lymphocele that was treated by laparoscopic fenestration. Subsequently, surgical reconstruction of urinary tract was required and success. Seven cases had mild to moderate hydronephrosis identified on CDU; 4 were due to a lymphocele; 3 were secondary to urinary tract stones. Four patients had renal pelvis prominence on CDU, which was spontaneously resolved with satisfactory renal function. Conclusion:From this study, it is demonstrated that urine leakage can be prevented and ureteric stricture may be minimised by using this modified LG technique. The ureter was always shortened in an adequate length and a ureteric stent was inserted. This modification is simple and reproducible by placing additional two stitches, which secure the potential gap at the entrance of ureter to the bladder.

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Urological complications after living‐donor renal transplantation

Abstract: Egypt percutaneous drainage reduces morbidity and the likelihood loss of graft function. Proper and prompt management should not affect the graft and/or the patient's survival.

Cited by 86 publications

References 44 publications

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

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

Potential of Noninvasive Serial Assessment of Acute Renal Allograft Rejection by ¹⁸F-FDG PET to Monitor Treatment Efficiency

Preventable Urological Complications Post Kidney Transplant with Modified Lich-Gregoir Technique for Ureteroneocystostomy

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Urological complications after living‐donor renal transplantation

Abstract: Egypt percutaneous drainage reduces morbidity and the likelihood loss of graft function. Proper and prompt management should not affect the graft and/or the patient's survival.

Cited by 86 publications

References 44 publications

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

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

Potential of Noninvasive Serial Assessment of Acute Renal Allograft Rejection by 18F-FDG PET to Monitor Treatment Efficiency

Preventable Urological Complications Post Kidney Transplant with Modified Lich-Gregoir Technique for Ureteroneocystostomy

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Potential of Noninvasive Serial Assessment of Acute Renal Allograft Rejection by ¹⁸F-FDG PET to Monitor Treatment Efficiency