Surgical complications in renal transplant in a tertiary centre in Pakistan
Rehan Mohsin1, Asad Shahzad1, Gauhar Sultan1, Bux Ali1, Haider Mehdi1, Altaf Hashmi1, Adib Rizvi1.
1Urology and Transplantation, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Introduction: The treatment of choice for patients with end stage renal disease is renal transplantation. Despite improvement in peritoneal dialysis and hemodialysis, renal transplant patients survive much longer after receiving a kidney transplant. This is attributed to improved immunosuppressive regimes and advancement in organ storage and surgical technique. Despite the success of renal transplantation postoperative complications can be expected and are not categorically benign, thus making it a double edged sword. Post-operative complications account for 15% - 17% of all cases and are associated with significant morbidity. Complications of renal transplantation can be classified as pathological or surgical entities. Surgical complications can be categorized as vascular complications (arteries, venous thrombosis, transplant renal arterial stenosis, graft rupture, hematoma, etc.) and Urological complications (ureteral obstruction, VUR, urinary leak and fistula). Knowledge of the incidence of clinical manifestation and management of surgical complication is necessary for all kidney transplant surgeons.
Objective: Objective of the study is to evaluate the frequency of surgical complications after renal transplant at SIUT.
Material and Methods: This is a retrospective cross sectional/cohort study planned to determine patient with organ survival rates along with post-transplant complications from living donor during 1 year from Jan 2018 to Dec 2018. Case notes of all the patients were evaluated and relevant information were gathered.
Result was analyzed for patient and donor gender, age of donor and recipients, cause of ESRD, HLA match, single V/S double/triple renal vessels, ischemia time, use of DJ stent and post-operative surgical complications. Data was analyzed using SPSS version 22.
Result: From January 1st to 31st December 2018 total of 300 renal transplants were done. Male to female ratio was 3.1 : 1. Most common complication noted in this time period was lymphocele which accounts for 8.6%. Ureteric complication were seen in 2.6% of cases. Wound infection were seen in 2.3% of cases. Three patients were presented with forgotten JJ stents. Immediate vascular complications were seen in 3 cases who required redo vascular anastomosis. Exploration was done in 6% of cases because of hematoma and anuria graft. Two patients had graft nephrectomy because of anastomotic site bleeding.
Conclusion: Surgical complications after renal transplant are common even at experienced centers. Familiarity with these complications is of utmost importance as early diagnosis and prompt management increase the long term graft survival.