Asymptomatic donor stones: Management algorithm
Anant Kumar1, Ruchir Maheshwari1, Devanshu Bansal1, Amit Bansal1, Vikas Singh1, Pragnesh Desai1, Samit Chaturvedi1.
1Urology, Uro-oncology, Robotics and Renal Transplantation, Max Healthcare, New Delhi, India
Introduction: Kidney transplantation in India is largely a live donor program. With incorporation of Computed Tomogram Angiography (CTA) during donor workup, significant number of renal stones are diagnosed. Herein, we present our experience and management algorithm of asymptomatic donor kidney stones.
Materials and Methods: We retrospectively reviewed all donor and recipient files of transplants done between April 2013 and September 2018 done in our institute. All records of donors diagnosed with asymptomatic renal stones were analyzed for demography, stone size, metabolic workup, intraoperative management and follow up. Recipient follow up records were evaluated for any stone related event including surgical intervention. Our algorithm of asymptomatic donor stone management is as depicted in Figure 1.
Results: Between April 2013 and September 2018, 1083 transplants were done. Follow up of 827 patients could be retrieved from hospital electronic health record (EHR). The results described in Figure 2. We do not use Ho LASER to fragment stones due to risk of injury to avascular graft kidney. No recurrence was seen in donors.
Conclusion: Donors with asymptomatic stones could be safely accepted, provided metabolic workup is negative. We believe our algorithm is a practical and safe approach to deal with asymptomatic donor stones.
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