Timely surgical intervention for ureteric complications ensures adequate graft function in renal transplantation: A 10-year review
Joseph Jaya1,2, Sherry Salter1,2, Alice Lee2, Nancy Suh2,3, Alan Saunder1.
1Department of Vascular and Transplantation Surgery, Monash Health, Melbourne, Australia; 2Department of General Surgery, Monash Health, Melbourne, Australia; 3Department of Nephrology Surgery, The Royal Melbourne Hospital, Melbourne, Australia
Introduction: Ureteric complications can cause significant morbidity in renal and simultaneous pancreas-kidney (SPK) transplantation. This 10-year review identified transplant patients with ureteric complications necessitating surgical intervention in an Australian tertiary centre.
Materials and Methods: The hospital records were scrutinised in detail to identify all patients who underwent renal or SPK transplantation from 1 June 2009 to 31 May 2019 with subsequent surgical management of ureteric complications. A case series of patients with ureteric complications was generated and findings analysed.
Results and Discussion: A total of 893 renal and SPK transplants were performed over the 10-year period. Ten of these (1.12%; 7 renal, 3 SPK) had ureteric complications. All were managed surgically. Five of the 10 had ureteric leaks (0.56%); 3 had ureteric strictures (0.34%); 1 had ureteric obstruction from extraluminal compression (0.11%); and 1 had both leak and stricture (0.11%). All 10 patients underwent ureteric reimplantation rather than radiological or endoscopic management. Two patients required more than one operation for their ureteric complication. No graft loss or surgical mortality occurred. All 10 patients currently have functioning kidney transplants, and none require maintenance dialysis.
Conclusion: We report a low rate (1.12%) of ureteric complications in our renal and SPK transplants. Our standard practice of definitive correction by ureteric reimplantation is proving successful. The authors confirm that appropriate surgery is a viable and durable option in renal transplant patients with excellent graft outcomes.
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