Urological Consequences following Renal Transplantation: A Review of the Literature

Palazzetti, Anna; Oderda, Marco; Dalmasso, Ettore; Falcone, Marco; Bosio, Andrea; Sedigh, O.; Frea, Bruno

doi:10.5301/uro.5000132

Cited by 7 publications

(7 citation statements)

References 92 publications

(114 reference statements)

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“…Ureteral strictures are mainly due to ureteral ischemia resulting in fibrosis, immunological factors, infections, extrinsic compression by hematoma or lymphocele, and acute or chronic rejec- tion episodes. [9][10][11] Ureteral stenting after balloon dilatation or surgical reconstruction is the treatment options for the management of these strictures. Although reimplantation of the ureter is the treatment of choice for the ureterovesical complications, the use of native ureter, when available, as pyeloureterostomy or ureteroureterostomy, is a valuable management alternative, with good long-term results reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

An updated analysis of the surgical and urological complications of 789 living related donor kidney transplantations: Experience of a single center

Oktar

Koçak

Tefik

et al. 2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: This study aims to review retrospectively the surgical and urological complications encountered in 789 cases of living-related donor kidney transplantations (LRDKTs). METHODS:In this study, the clinical records of 789 LRDKTs, which were performed between 1983 and 2017, were reviewed retrospectively concerning surgical and urological complications. RESULTS:Overall, urological and surgical complications were encountered in 87 (11.02%) of the cases. Of the 789 patients, urological complications were detected in 44 of them (5.6%), including 8 urinary fistula (with 1 distal ureteral necrosis), 10 ureteric stenosis, 1 renal calculus, 9 symptomatic vesicoureteral reflux and 16 lymphoceles requiring intervention. As surgical complications (n=43), vascular complications were encountered in 8 cases; there were 5 cases with renal artery stenosis and 3 with renal vein thrombus. Wound infection was detected in 14 patients. Eighteen patients underwent surgical explorations due to perinephric hematoma during the early postoperative period. Renal allograft rupture due to accelerated rejection was developed in 2 cases. A lower segmental arterial injury occurred in 1 patient during the operation. CONCLUSION:In our series, urological and surgical complications were detected in 11.02% of the recipients. Although complications still encountered, early identification of these complications with proper management strategies significantly decreases the risk of graft loss.

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Section: Discussionmentioning

confidence: 99%

An updated analysis of the surgical and urological complications of 789 living related donor kidney transplantations: Experience of a single center

Oktar

Koçak

Tefik

et al. 2019

Ulus Travma Acil Cerrahi Derg

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show abstract

“…As shown in Table 3, rejections, number of biopsies, NODAT and glomerulonephritis were associated with higher 1-year PTO, surprisingly with similar distribution between donor age groups (data not shown); overall infections and CMV viremia as well as vascular and urological complications were, on the contrary, significantly more frequent in older donor population (data not shown). These data could be explained as a consequence of the indication for decreasing immunosuppressive therapy in case of infection and of the lower quality of older donor tissues in comparison with the younger donor kidneys [29, 30]. Notably, we found a strong correlation between overall infection and rejection rates, especially when donor age was > 50 years.…”

Section: Discussionmentioning

confidence: 82%

Relationship between early proteinuria and long term outcome of kidney transplanted patients from different decades of donor age

et al. 2019

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BackgroundProteinuria after kidney transplantation portends a worse graft survival. However the magnitude of proteinuria related to patient and graft survival and its correlation with donor and recipient characteristics are poorly explored.MethodsThis study investigated the impact of post transplant proteinuria in the first year in 1127 kidney transplants analyzing the impact of different donor ages. Proteinuria cut off was set at 0.5 g/day.ResultsTransplants with proteinuria > 0.5 g/day correlated with poor graft and patient outcome in all donor age groups. In addition, 6-month-1-year proteinuria increase was significantly associated with graft outcome, especially with donors > 60 years old (p < 0.05; Odd Ratio 1.8). 1-year graft function (eGFR < or ≥ 44 ml/min) had similar impact to proteinuria (≥ 0.5 g/day) on graft failure (Hazard Ratio 2.77 vs Hazard Ratio 2.46). Low-grade proteinuria (0.2–0.5 g/day) demonstrated a trend for worse graft survival with increasing donor age. Also in kidney-paired analysis proteinuria ≥0.5 effect was more significant with donors > 50 years old (Odd Ratio 2.3).ConclusionsPost-transplant proteinuria was increasingly harmful with older donor age. Proteinuria ≥0.5 g/day correlates with worse outcomes in all transplanted patients. Prognostic value of proteinuria and eGFR for graft and patient survival was comparable and these two variables remain significant risk factors even in a multivariate model that take into consideration the most important clinical variables (donor age, rejection, delayed graft function and cytomegalovirus viremia among others).

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“…1,2 Urologic complications are highly relevant as they may end up in graft loss. 3,4 In particular, ureteral complications have been reported from 4.8% to 9.2%, with ureteral stenosis (US) rates from 2.4% to 9.2% of the kidney transplants. [5][6][7] Additionally, most ureteral complications occur during the first posttransplant year.…”

Section: Introductionmentioning

confidence: 99%

Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

Cayetano-Alcaraz

Rodriguez-Alvarez

Vilatobá-Chapa

et al. 2019

CUAJ

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Introduction: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. Methods: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008–2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. Results: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36–4.37) and ureteral duplication (OR 3.29; 95% CI 2.40–4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96–11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors. Conclusions: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.

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Urological Consequences following Renal Transplantation: A Review of the Literature

Cited by 7 publications

References 92 publications

An updated analysis of the surgical and urological complications of 789 living related donor kidney transplantations: Experience of a single center

An updated analysis of the surgical and urological complications of 789 living related donor kidney transplantations: Experience of a single center

Relationship between early proteinuria and long term outcome of kidney transplanted patients from different decades of donor age

Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

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