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Surgical management of early and late ureteral complications after renal transplantation: techniques and outcomes
Author(s) -
Berli Jens U.,
Montgomery John R.,
Segev Dorry L.,
Ratner Lloyd E.,
Maley Warren R.,
Cooper Matthew,
Melancon Joseph K.,
Burdick James,
Desai Niraj M.,
Dagher Nabil N.,
Lonze Bonnie E.,
Nazarian Susanna M.,
Montgomery Robert A.
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12478
Subject(s) - medicine , anastomosis , surgery , ureter , transplantation , urinary system , retrospective cohort study , kidney transplantation , stenosis , cohort , proportional hazards model , population , urology , environmental health
Background In this study, we present our experience with ureteral complications requiring revision surgery after renal transplantation and compare our results to a matched control population. Methods We performed a retrospective analysis of our database between 1997 and 2012. We divided the cases into early (<60 d) and late repairs. Kaplan–Meier and Cox proportional hazards models were used to compare graft survival between the intervention cohort and controls generated from the Scientific Registry of Transplant Recipients data set. Results Of 2671 kidney transplantations, 51 patients were identified as to having undergone 53 ureteral revision procedures; 43.4% of cases were performed within 60 d of the transplant and were all associated with urinary leaks, and 49% demonstrated ureteral stenosis. Reflux allograft pyelonephritis and ureterolithiasis were each the indication for intervention in 3.8%; 15.1% of the lesions were located at the anastomotic site, 37.7% in the distal segment, 7.5% in the middle segment, 5.7% proximal ureter, and 15.1% had a long segmental stenosis. In 18.9%, the location was not specified. Techniques used included ureterocystostomy (30.2%), ureteroureterostomy (34%), ureteropyelostomy (30.1%), pyeloileostomy (1.9%), and ureteroileostomy (3.8%). No difference in overall graft survival ( HR 1.24 95% CI 0.33–4.64, p = 0.7) was detected when compared to the matched control group. Conclusion Using a variety of techniques designed to re‐establish effective urinary flow, we have been able to salvage a high percentage of these allografts. When performed by an experienced team, a ureteric complication does not significantly impact graft survival or function as compared to a matched control group.