Urological and surgical complications of renal transplant recipients as a single-center experience Urological and surgical complications of renal transplant recipients as a single-center experience

Main Article Content

Safaa G. Mezban
Adnan Athafa
Ismiel Khalfa Abood

Keywords

Kidney transplantation, ESRD, urinary leak, lymphocele, Basrah

Abstract

Background: Kidney transplantation is considered the most effective therapy for end-stage renal disease (ESRD). Postoperative complications continue to occur in nearly 12–20% of patients. These complications can be sub-divided into three categories: vascular, urologic, and nephrogenic.


Objective: To determine the surgical and urological complications of renal transplant in Basra Training Center.


Patients and Methods: A prospective descriptive study was done on 71 patients who underwent renal transplant surgery between October 2015 and August 2018. After taking their informed consent, preoperative antibiotics were given, and the procedure was done under general anesthesia. In all the transplantations, the renal vein of the donor was anastomosed to the external iliac vein of the recipient with an end-to-side. While the renal artery anastomosed to the internal iliac artery of the recipient with an end-to-end for the first 50 cases, in the other 21 cases, renal artery anastomosed to the external iliac artery of the recipient with an end-to-side anastomosis. Ureters were anastomosed by the Lich–Gregoire procedure.


Results: Overall, urological and surgical complications were encountered in 12 of the renal transplants recipients from the total number (71, 17%). This study included a total of 71 patients (59 male and 12 female, 83% and 17%, respectively). The complications that occurred during the follow-ups of the patients were as follows: one patient developed urinary leak (1.4%), five patients developed lymphocele (7%), four patients complained of acute pyelo nephritis (6%), one patients (1.4%) complained of wound infection, and one complained of renal stone (1.4%).


Conclusions: In conclusion, urological complications such as lymphocele (7%) and acute graft pyelonephritis (AGPN) (6%) remain the most common type of surgical complications following kidney transplantation (in this study). Our urological and surgical complication rate was relatively low compared to others noted in the literature.


 

Abstract 271 | Full text PDF Downloads 28

References

1. Merrill JP, Murray JE, Harrison JH, Guild WR. Successful homotransplantation of the human kidney between identical twins. Journal of the American Medical Association. 1999 Jan 28;160(4):277–82.
2. Wong G, Howard K, Chapman JR et al. Comparative survival and economic benefits of deceased donor kidney transplantation and dialysis in people with varying ages and co-morbidities. PLoS One. 2012;7:e29591
3. Orons PD, Zajko AB. Angiography and interventional aspects of renal transplantation. Radiologic Clinics of North America. 1995 May;33(3):461–71.
4. Kobayashi K, Censullo ML, Rossman LL, Kyriakides PN, Kahan BD, Cohen AM. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 2017 Jul;27(4):1109–30
5. Cassini MF, de Andrade MF, Junior ST. Surgical complications of renal transplantation. In Understanding the Complexities of Kidney Transplantation 2011. InTech.
6. Emiroğlu R, Karakayall H, Sevmiş S, Akkoc H, Bilgin N, Haberal M. Urologic complications in 1275 consecutive renal transplantations. In Transplantation proceedings 2001 (Vol. 33, No. 1–2, pp. 2016–17).
7. Shoskes DA, Hanbury D, Cranston D, Morris PJ. Urological complications in 1,000 consecutive renal transplant recipients. The Journal of Urology. 1995 Jan 1;153(1):18–21.
8. Hua-liang YU, Lin-yang Y, Mao-hu L, Yu Y, Rui M, Xiao-juan H. Treatment of benign ureteral stricture by double J stents using high-pressure balloon angioplasty. Chinese Medical Journal. 2011 Mar 1;124(6):943–46
9. Koçak T, Nane I, Ander H, Ziylan O, Oktar T, Ozsoy C. Urological and surgical complications in 362 consecutive living related donor kidney transplantations. Urologia Internationalis. 2004;72(3):252–56.
10. Starzl TE, Groth CG, Putnam CW, Penn I, Halgrimson CG, Flatmark A, Gecelter L, Brettschneider L, Stonington OG. Urological complications in 216 human recipients of renal transplants. Annals of Surgery. 1970 Jul;172(1):1.
11. Parthipun A, Pilcher J. Renal transplant assessment: sonographic imaging. Ultrasound Clinics. 2010 Jul 1;5(3):379–99.
12. Kahan BD, Ponticelli C. Surgical complications. Principles and practice of renal transplantation. 1st ed. London: Blackwell Science. 2000:219–50
13. Odland MD. Surgical technique/post-transplant surgical complications. Surgical Clinics. 1998 Feb 1;78(1):55–60.
14. Bennett LN, Voegeli DR, Crummy AB, McDermott JC, Jensen SR, Sollinger HW. Urologic complications following renal transplantation: role of interventional radiologic procedures. Radiology. 1986 Aug;160(2):531–36
15. Leonardou P, Gioldasi S, Pappas P. Transluminal angioplasty of transplanted renal artery stenosis: a review of the literature for its safety and efficacy. Journal of Transplantation. 2011 Apr 14;2011.
16. Yong AA, Ball ST, Pelling MX, Gedroyc WM, Morgan RA. Management of ureteral strictures in renal transplants by antegrade balloon dilatation and temporary internal stenting. Cardiovascular and Interventional Radiology. 1999 Sep 1;22(5):385–88.
17. Sebastià C, Quiroga S, Boyé R, Cantarell C, Fernandez-Planas M, Alvarez A. Helical CT in renal transplantation: normal findings and early and late complications. Radiographics. 2016 Sep;21(5):1103–17.
18. Sandhu C, Patel U. Renal transplantation dysfunction: the role of interventional radiology. Clinical Radiology. 2002 Sep 1;57(9):772–83.
19. Kuzuhara K, Nishimori S, Kurooka Y, Yanagisawa T, Otsubo O, Katori H, Yokoyama K, Ubara Y, Arizono K, Hinosita H. Conservative treatment of lymphocele after renal transplantation using 95% ethanol instillation. In Transplantation proceedings 1994 Aug (Vol. 26, No. 4, p. 1988).
20. Shokeir AA, El-Diasty TA, Ghoneim MA. Percutaneous treatment of lymphocele in renal transplant recipients. Journal of Endourology. 1993 Dec;7(6):481–85.
21. Brown ED, Chen MY, Wolfman NT, Ott DJ, Watson Jr NE. Complications of renal transplantation: evaluation with US and radionuclide imaging. Radiographics. 2000 May;20(3):607–22.
22. Rajiah P, Lim YY, Taylor P. Renal transplant imaging and complications. Abdominal Imaging. 2006 Dec 1;31(6):735–46.
23. Baden L, Katz J. Infectious disease issues in the well transplant patient. Graft. 2001 Jun 1;4(4):276.
24. Rubin RH. Infectious disease complications of renal transplantation. Kidney International. 1993 Jul 1;44(1):221–36.
25. Weingarten KE, D’Agostino HB, Dunn J, Steiner RW. Obturator herniation of the ureter in a renal transplant recipient causing hydronephrosis: perioperative percutaneous management. Journal of Vascular and Interventional Radiology. 1996 Nov 1;7(6):939–41.
26. Mundy AR, Podesta ML, Bewick M, Rudge CJ, Ellis FG. The urological complications of 1000 renal transplants. British Journal of Urology. 2017 Oct;53(5):397–402.
27. .Mäkisalo H, Eklund B, Salmela K, Isoniemi H, Kyllönen L, Höckerstedt K, Halme L, Ahonen J. Urological complications after 2084 consecutive kidney transplantations. In Transplantation proceedings 1997 (Vol. 29, No. 1–2, p. 152).
28. Odland MD. Surgical technique/post-transplant surgical complications. Surgical Clinics. 1998 Feb 1;78(1):55–60.
29. Dörsam J, Knopp MV, Carl S, Oesingmann N, Schad L, Brkovic D, Staehler G. Ureteral complications after kidney transplantation—evaluation with functional magnetic resonance urography. In Transplantation proceedings 1997 (Vol. 29, No. 1–2, pp. 132–135).
30. El‐Mekresh M, Osman Y, Ali‐El‐Dein B, El‐Diasty T, Ghoneim MA. Urological complications after living‐donor renal transplantation. BJU International. 2001 Mar;87(4):295–306.
31. Streeter EH, Little DM, Cranston DW, Morris PJ. The urological complications of renal transplantation: a series of 1535 patients. BJU International. 2002 Nov;90(7):627–34.
32. Risaliti A, Corno V, Donini A, Cautero N, Baccarani U, Pasqualucci A, Terrosu G, Cedolini C, Bresadola F. Laparoscopic treatment of symptomatic lymphoceles after kidney transplantation. Surgical Endoscopy. 2000 Mar 1;14(3):293–95.
33. Khauli RB, Stoff JS, Lovewell T, Ghavamian R, Baker S. Post-transplant lymphoceles: a critical look into the risk factors, pathophysiology, and management. The Journal of Urology. 1993 Jul 1;150(1):22–26.
34. Dinckan A, Tekin A, Turkyilmaz S, Kocak H, Gurkan A, Erdogan O, Tuncer M, Demirbas A. Early and late urological complications corrected surgically following renal transplantation. Transplant International. 2007 Aug;20(8):702–7.
35. Kim H, Cheigh JS, Ham HW. Urinary stones following renal transplantation. The Korean Journal of Internal Medicine. 2001 Jun;16(2):118.
36. Hess B, Metzger RM, Ackermann D, Montandon A, Jaeger P. Infection-induced stone formation in a renal allograft. American Journal of Kidney Diseases. 1994 Nov 1;24(5):868–72.
37. Wyatt J, Kolettis PN, Burns JR. Treatment outcomes for percutaneous nephrolithotomy in renal allografts. Journal of Endourology. 2009 Nov 1;23(11):1821–24.
38. Lynch RJ, Ranney DN, Shijie C, Lee DS, Samala N, Englesbe MJ. Obesity, surgical site infection, and outcome following renal transplantation. Annals of Surgery. 2009 Dec 1;250(6):1014–20.
39. .Snyder JJ, Israni AK, Peng Y, Zhang L, Simon TA, Kasiske BL. Rates of first infection following kidney transplant in the United States. Kidney International. 2009 Feb 1;75(3):317–26.
40. Sousa SR, Galante NZ, Barbosa DA, Pestana JO. Incidência e fatores de risco para complicações infecciosas no primeiro ano após o transplante renal. Jornal Brasileiro de Nefrologia. 2010 Mar 1.
41. Menezes FG, Wey SB, Peres CA, Medina-Pestana JO, Camargo LF. What is the impact of surgical site infection on graft function in kidney transplant recipients? Transpl Infect Dis 2015;12(5):392–96.
42. Røine E, Bjørk IT, Øyen O. Targeting risk factors for impaired wound healing and wound complications after kidney transplantation. In Transplantation proceedings 2010 Sep 1 (Vol. 42, No. 7, pp. 2542–46). Elsevier.
43. Schmaldienst S, Dittrich E, Hörl WH. Urinary tract infections after renal transplantation. Current Opinion in Urology. 2002 Mar 1;12(2):125–30.
44. Säemann M, Hörl WH. Urinary tract infection in renal transplant recipients. European Journal of Clinical Investigation. 2008 Oct;38:58–65.
45. Abbott KC, Swanson SJ, Richter ER, Bohen EM, Agodoa LY, Peters TG, Barbour G, Lipnick R, Cruess DF. Late urinary tract infection after renal transplantation in the United States. American Journal of Kidney Diseases. 2014 Aug 1;44(2):353–62.
46. Pelle G, Vimont S, Levy PP, Hertig A, Ouali N, Chassin C, Arlet G, Rondeau E, Vandewalle A. Acute pyelonephritis represents a risk factor impairing long‐term kidney graft function. American Journal of Transplantation. 2017 Apr;7(4):899–907.
47. Dharnidharka VR, Agodoa LY, Abbott KC. Effects of urinary tract infection on outcomes after renal transplantation in children. Clinical Journal of the American Society of Nephrology. 2007 Jan 1;2(1):100–6.
48. Kamath NS, John GT, Neelakantan N, Kirubakaran MG, Jacob CK. Acute graft pyelonephritis following renal transplantation. Transplant Infectious Disease. 2006 Sep 1;8(3):140–7.
49. Valera B, Gentil MA, Cabello V, Fijo J, Cordero E, Cisneros JM. Epidemiology of urinary infections in renal transplant recipients. In Transplantation proceedings 2016 Oct 1 (Vol. 38, No. 8, pp. 2414–15). Elsevier.

Similar Articles

1-10 of 61

You may also start an advanced similarity search for this article.