Surgical management of early and late ureteral complications after renal transplantation: Techniques and outcomes

Jens U. Berli, John R. Montgomery, Dorry L. Segev, Lloyd E. Ratner, Warren R. Maley, Matthew Cooper, Joseph K. Melancon, James Burdick, Niraj M. Desai, Nabil N Dagher, Bonnie Lonze, Susanna M. Nazarian, Robert A. Montgomery

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)26-33
Number of pages8
JournalClinical Transplantation
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Renal transplantation
  • Ureteral complications
  • Ureteral leak
  • Ureteral revision
  • Ureteral stenosis

ASJC Scopus subject areas

  • Transplantation

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