Urological complications following renal transplantation.

Abstract

A total of 1016 consecutive renal transplants performed between 1976 and 1990 were analysed retrospectively to determine the incidence of urological complications and possible predisposing factors. Some 189 episodes of ureteric obstruction and/or urinary leak occurred in 143 patients (overall incidence 14.1%). The median annual rate of urinary leak was 5.1%; that of ureteric obstruction was 4.5% pre-1986 and 16.1% post-1986. Sixty-three episodes of urinary leak occurred in 54 patients from 1 day to 3 months post-transplant and 60% involved the distal ureter. Thirty were treated primarily by reconstructive surgery, ten required nephrectomy and three died of associated sepsis. A total of 126 episodes of ureteric obstruction occurred in 104 patients from 1 day to 12 years post-transplant and 86% involved the distal ureter. Prior to 1986, 10/11 patients with ureteric obstruction were treated by reconstructive surgery, but since then 88 (95%) have been treated by percutaneous nephrostomy, with or without stenting, with only one graft lost and no deaths. Children had a significantly increased incidence of ureteric obstruction (P < 0.001) whilst male recipients had an increased incidence of urinary leak (P = 0.04). More patients with ureteric obstruction than those without had two or more episodes of rejection (P = 0.03). No single cause for the increased incidence of ureteric obstruction since 1986 has been identified. Continued attention to technical detail and further study of this trend is warranted.

Urological Complications in Pediatric Renal Transplantation

“…As in the publication of Rigg et al [5]the majority (7 of 8) of our patients with urinary leakage are male recipients. This higher frequency is currently unexplained and not due to previous treatment of posterior urethral valves as was the case in only 1 patient.…”

“…In the literature especially urinary leakage and obstruction have a considerable mortality rate [5, 9, 10]. In our own group, no patient died because of a urological complication.…”

“…Although rejection is the main cause of graft failure, urological complications can also play a role in graft loss and even patient mortality. The incidence of urological complications after kidney transplantation has been reported to range from 0 to 33% [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13], although data are not really comparable because some authors include only major urological complications, whereas others even include urinary tract infections. A higher rate of complications can be expected in children compared with adults, due to the higher number of patients with congenital urinary tract abnormalities often seen in combination with bladder dysfunction.…”

“…More or less the same procedure is always applied in our center, including the use of a ureteral splint and a large–size wound drain, although in the literature ureteral reimplantation without a splint is also described [2, 10, 16]. Several authors report good results with transcutaneous dilatation of a short ureteral stenosis, which failed in our attempts in 2 patients [5, 15]. Ureteral stenosis is probably caused by local ischemia from a decreased vascularization or as a tissue reaction in case of a rejection process.…”

“…Sometimes only a brief referral is given about these complications in publications about graft survival. A summary of complications in pediatric patients reported in the literature and our own series is given in table 1 [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12]. …”