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Heidenberg DJ, Choudry MM, Briggs LG, Ahmadieh K, Abdul-Muhsin HM, Katariya NN, Cheney SM. Robotic-Assisted Laparoscopic Repair of Kidney Transplant Ureteral Strictures. Urology 2024:S0090-4295(24)00347-9. [PMID: 38729270 DOI: 10.1016/j.urology.2024.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND OBJECTIVE To evaluate outcomes of robotic assisted transplant ureteral repair (RATUR) for the management of kidney transplant ureteral strictures (TUS). METHODS We retrospectively analyzed 41 consecutive patients who underwent RATUR for TUS at multiple tertiary referral centers between January 2016 and December 2022. RATUR was performed utilizing a robotic assisted transperitoneal approach. The primary outcome was stricture recurrence rate and secondary outcomes included postoperative complicate rate, determining factors impacting with allograft functional recovery, and rate of conversion to open surgery. Categorical and continuous variables are displayed as total number (Percentage) or median [Interquartile Range] respectively. Pearson correlation coefficient was utilized to assess categorical variable correlation with creatinine. RESULTS The median age was 56 years [44, 66]. The female to male ratio was 1.1:1. Approximately 66% of patients were dialysis dependent prior to kidney transplantation. TUS was identified at a median time of 4 months [2, 15.5] following kidney transplant. Median stricture length was 2 cm [1.22, 2.9cm]. There were no TUS recurrences with a median follow-up of 36 months [24, 48]. There were 3 Clavien Grade 2 and 1 Clavien grade 3 complications (9.5%). No baseline characteristics or preoperative diagnostics were correlated with a long-term decline in renal allograft function. CONCLUSION RATUR has excellent and durable outcomes with low complication rates. These findings encourage the use of a minimally invasive definitive repair as a first line treatment option for the management of TUS.
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Caamiña L, Pietropaolo A, Prudhomme T, Bañuelos B, Boissier R, Pecoraro A, Campi R, Dönmez MI, Sierra A, Piana A, Somani BK, Territo A. Endourological Management of Ureteral Stricture in Patients with Renal Transplant: A Systematic Review of Literature. J Endourol 2024; 38:290-300. [PMID: 38185833 DOI: 10.1089/end.2023.0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Purpose: To analyze the utility and outcomes of available endourologic options to treat ureteral stricture after kidney transplantation (KT). Methods: A systematic review was carried out for all English language articles from 2000 to 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards using EMBASE, MEDLINE, SCOPUS, Google scholar, and Cochrane library. The search term combination for the string was follows: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter) OR (Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS-I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilatation (ureteroplasty) with or without laser was used as initial approaches whereas follow-up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after KT is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourologic management is a safe option with good long-term outcomes, especially in short and early strictures.
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Affiliation(s)
- Leticia Caamiña
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
| | - Thomas Prudhomme
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Beatriz Bañuelos
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Division Renal Transplantation and Reconstructive Urology, Hospital Universitario El Clínico San Carlos, Madrid, Spain
| | - Romain Boissier
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Alessio Pecoraro
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Riccardo Campi
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Muhammet Irfan Dönmez
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alba Sierra
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Piana
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, University of Turin, Turin, Italy
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Angelo Territo
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Gao X, Di X, Chen G, Wang W, Peng L, Chen J, Wei X. Metal ureteral stents for ureteral stricture: 2 years of experience with 246 cases. Int J Surg 2024; 110:66-71. [PMID: 37812177 PMCID: PMC10793778 DOI: 10.1097/js9.0000000000000841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Metal ureteral stents (MUS) has gained popularity as an endoscopic treatment alternative for the management of ureteral strictures. The aim of this study was to evaluate the safety, efficacy, and tolerability of MUS for treating ureteral strictures and to identify any factors that could influence the success of this intervention. METHODS This study is a prospective analysis of the efficacy and safety of MUS for treating ureteral strictures in a single-center setting. The study enrolled 246 patients who had been diagnosed with ureteral strictures and had undergone MUS placement between January 2019 and July 2021. The patients were followed-up for a duration of 2 years. RESULTS The overall success rate of MUS placement was 71.7%. Furthermore, the success rate of ureteral strictures after kidney transplantation (78.2%) was significantly higher than common ureteral strictures (73.0%) or recurrent ureteral strictures (67.6%). Additionally, postsurgery, there was a considerable reduction in hydronephrosis volume (68.9±96.1 vs. 32.1±48.8 cm 3 ), blood creatinine level (103.7±49.8 vs. 94.4±47.5 mol/l) and urea nitrogen level (6.7±7.2 vs. 5.1±2.4 mmol/l). The study also reported that the rate of adverse events associated with MUS was relatively low, included hematuria (7.9%), pain (6.8%), urinary tract infection (6.4%), and lower urinary tract symptoms (5.3%). CONCLUSIONS MUS appear to be a safe and effective treatment option for ureteral strictures, with a high success rate and low complication rate. These results have important implications for the management of ureteral strictures and can help guide clinical decision-making in the selection of treatment options.
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Affiliation(s)
| | | | | | | | | | | | - Xin Wei
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Zhang J, Xue W, Tian P, Zheng J, Ding C, Li Y, Wang Y, Ding X, Lv Y. Effect of ureteral stricture in transplant kidney and choice of treatment on long-term graft survival. Int Urol Nephrol 2023; 55:2193-2203. [PMID: 37308613 PMCID: PMC10406706 DOI: 10.1007/s11255-023-03669-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND To explore the risk factors of ureteral stricture in transplant kidney and the clinical effects of different treatment methods. METHODS The 62 patients with transplant kidney ureteral stenosis as the experimental group, and another group of recipients from the same donor as the control group (n = 59 cases). The risk factors for ureteral stricture and the survival rate of transplant kidney were analyzed and compared. The 62 patients were divided into open operation, luminal operation, and magnetic compression anastomosis (MCA) operation group. The effect of the operation and the survival rate of transplant kidney among the three groups were compared. RESULTS In our study, we found that the above differences were statistically significant in clinical data such as gender, multiple donor renal arteries, history of infection, and delayed graft function (DGF) between the two groups (P < 0.05). Urinary tract infection and DGF history were the independent risk factors for the development of ureteral stricture. The open operation had the best treatment effect and the survival rate of the transplant kidney, followed by the MCA, the stricture recurrence rate in the luminal operation was the highest. CONCLUSION The ureteral stricture has a negative correlation with the long-term survival rate of the transplant kidney, the curative rate and long-term effect of open surgery are the best, stricture recurrence rate of luminal surgery is high, and it may require multiple operations in the future, the MCA is a new breakthrough and innovation in the treatment of ureteral stricture.
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Affiliation(s)
- Jiangwei Zhang
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Wujun Xue
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Puxun Tian
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jin Zheng
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chenguang Ding
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yang Li
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ying Wang
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xiaoming Ding
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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Territo A, Bravo-Balado A, Andras I, Campi R, Pecoraro A, Hevia V, Prudhomme T, Baboudjian M, Gallioli A, Verri P, Charbonnier M, Boissier R, Breda A. Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration. World J Urol 2023; 41:1951-1957. [PMID: 37340277 PMCID: PMC10352153 DOI: 10.1007/s00345-023-04455-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/22/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Ureteral stenosis (US) in kidney transplant (KT) recipients is associated with poorer long-term graft survival. Surgical repair is the standard of care, and endoscopic treatment represents an alternative for stenosis < 3 cm. We aimed to determine the effectiveness and safety of endourological management of US in KT patients and predictors of failure. METHODS A retrospective multicenter study was conducted in four European referral centers, including all KT patients with US managed endoscopically between 2009 and 2021. Clinical success was defined as the absence of upper urinary tract catheterization, surgical repair or transplantectomy during follow-up. RESULTS A total of 44 patients were included. The median time to US onset was 3.5 months (IQR 1.9-10.8), the median length of stricture was 10 mm (IQR 7-20). Management of US involved balloon dilation and laser incision in 34 (79.1%) and 6 (13.9%) cases, respectively, while 2 (4.7%) received both. Clavien-Dindo complications were infrequent (10%); only one Clavien ≥ III complication was reported. Clinical success was 61% at last follow-up visit (median = 44.6 months). In the bivariate analysis, duckbill-shaped stenosis (vs. flat/concave) was associated with treatment success (RR = 0.39, p = 0.04, 95% CI 0.12-0.76), while late-onset stenosis (> 3 months post KT) with treatment failure (RR = 2.00, p = 0.02, 95% CI 1.01-3.95). CONCLUSIONS Considering the acceptable long-term results and the safety of these procedures, we believe that the endoscopic treatment should be offered as a first-line therapy for selected KT patients with US. Those with a short and duckbill-shaped stenosis diagnosed within 3 months of KT seem to be the best candidates.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Alejandra Bravo-Balado
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain.
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | - Riccardo Campi
- Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | - Vital Hevia
- Hospital Universitario Ramón y Cajal. Alcalá University. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - Michael Baboudjian
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Mathieu Charbonnier
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Alberto Breda
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
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Zhang J, Xue W, Tian P, Yan H, Zheng J, Li X, Wang Y, Ding X, Lyu Y. Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation. Chin Med J (Engl) 2023; 136:1006-1008. [PMID: 37017563 PMCID: PMC10278697 DOI: 10.1097/cm9.0000000000002325] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Indexed: 04/06/2023] Open
Affiliation(s)
- Jiangwei Zhang
- Department of Kidney Transplantation, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
| | - Wujun Xue
- Department of Kidney Transplantation, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
| | - Puxun Tian
- Department of Kidney Transplantation, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
| | - Hang Yan
- Department of Kidney Transplantation, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
| | - Jin Zheng
- Department of Kidney Transplantation, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
| | - Xiao Li
- Department of Kidney Transplantation, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
| | - Ying Wang
- Department of Kidney Transplantation, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
| | - Xiaoming Ding
- Department of Kidney Transplantation, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China
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Santos Pérez de la Blanca R, Medina-Polo J, Peña-Vallejo H, Juste-Álvarez S, Pamplona-Casamayor M, Duarte-Ojeda JM, Miranda Utrera N, García-González L, Arrébola-Pajares A, Rodríguez Antolín A, Tejido-Sánchez Á. Ureteral Stenosis and Fistula after Kidney Transplantation. Urol Int 2023; 107:157-164. [PMID: 35468605 DOI: 10.1159/000523690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center. METHODS Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas. RESULTS Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948). CONCLUSION Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival.
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Affiliation(s)
| | - Jose Medina-Polo
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Helena Peña-Vallejo
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Silvia Juste-Álvarez
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | | | | | | | - Ana Arrébola-Pajares
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Ángel Tejido-Sánchez
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
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Gerken ALH, Nowak K, Meyer A, Kriegmair MC, Weiss C, Krämer BK, Glossner P, Heller K, Karampinis I, Kunath F, Rahbari NN, Schwenke K, Reissfelder C, Lang W, Rother U. Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green. J Clin Med 2022; 11:6585. [PMID: 36362813 PMCID: PMC9656022 DOI: 10.3390/jcm11216585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Ureteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indocyanine green (ICG) fluorescence angiography. This bicentric historic cohort study, conducted between November 2015 and December 2019, included 196 kidney transplantations. The associations between quantitative perfusion parameters of near-infrared fluorescence angiography with ICG and the occurrence of different grades of ureterovesical anastomosis complications in the context of donor, recipient, periprocedural, and postoperative characteristics were evaluated. Post-transplant ureterovesical anastomosis complications occurred in 18%. Complications were defined and graded into three categories. They were associated with the time on dialysis (p = 0.0025), the type of donation (p = 0.0404), and the number of postoperative dialysis sessions (p = 0.0173). Median ICG ingress at the proximal ureteral third was 14.00 (5.00–33.00) AU in patients with and 23.50 (4.00–117.00) AU in patients without complications (p = 0.0001, cutoff: 16 AU, sensitivity 70%, specificity 70%, AUC = 0.725, p = 0.0011). The proposed definition and grading of post-transplant ureterovesical anastomosis complications is intended to enable valid comparisons between studies. ICG Fluorescence angiography allows intraoperative quantitative assessment of ureteral microperfusion during kidney transplantation and is able to predict the incidence of ureterovesical anastomosis complications. Registration number: NCT-02775838.
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Tang W, Niu H, Yang Y, Li H, Liu H, Zhang J, Zhang P. The Clinical Study of Bladder Flap Ureteroplasty (Psoas Hitch) in the Treatment of Lower Ureteral Injuries and Strictures (19 Cases). Evid Based Complement Alternat Med 2022; 2022:4607735. [PMID: 35656474 DOI: 10.1155/2022/4607735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to investigate the efficacy and safety of bladder flap ureteroplasty (psoas hitch) in the treatment of lower ureteral injuries and strictures. Methods 19 patients with lower ureteral injuries and strictures scheduled for a bladder flap ureteroplasty (psoas hitch) in our hospital from January 2020 to January 2021 were recruited. The outcome measures included treatment efficacy and safety. Results The operative time, intraoperative bleeding, catheter extubation time, hospital stay, extubation time of ureteral stent, and follow-up time were (125.36 ± 15.38) min, (75.37 ± 11.09) ml, (7.25 ± 1.04) d, (8.76 ± 1.11) d, (46.34 ± 7.66) d, and(19.27 ± 1.27) months, respectively. No serious perioperative adverse reactions were observed, and all the symptoms of patients were relieved. Conclusion Bladder flap ureteroplasty (psoas hitch) is safe and effective for the treatment of lower ureteral injuries, with advantages such as less intraoperative bleeding and trauma and rapid recovery, so it is worthy of promotion. This was a retrospective study supervised by the Ethics Committee of Hebei Yanda Hospital.This trial is registered with no. hebYD076.
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Abstract
INTRODUCTION Allograft ureteral strictures after renal transplantation impact graft function and increase patient morbidity. They can be challenging to treat and may require complex surgical repair. Therefore, the objective of this study was to identify contemporary risk factors for the development of post-renal transplant ureteral strictures. METHODS A retrospective analysis was performed on all renal transplant patients at Vancouver General Hospital from 2008-2019. Demographics, clinical parameters, and outcomes were compared between patients who did and did not develop ureteral strictures. Putative risk factors for ureteral stricture were analyzed using logistic regression. RESULTS A total of 1167 patients were included with a mean followup of 61.9±40.8 months. Ureteral strictures occurred in 25 patients (2.1%). Stricture patients had no demographic differences compared to non-stricture patients but had significantly higher rates of postoperative complications, longer hospital stays, and decreased renal function one year post-transplant (all p<0.05). On multivariable analysis, cold ischemia time >435 minutes (odds ratio [OR] 43.9, confidence interval [CI] 1.6-1238.8, p=0.027), acute rejection (OR 3.0, CI 1.1-7.4, p=0.027), and postoperative complications (OR 112.4, CI 2.4-5332.6, p=0.016) were risk factors for stricture. CONCLUSIONS Renal transplant patients with ureteral stricture experience greater morbidity and reduced post-transplant renal function compared to non-stricture patients. Our findings support attempts to reduce cold ischemia time, acute rejection, and postoperative complications to mitigate this potential complication. Our study is limited by the low incidence of ureteral stricture resulting in a small sample of stricture patients. Future research in a larger, multicenter setting is warranted.
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Affiliation(s)
- Anna J Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - David Harriman
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Nguan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Mesnard B, Leroy M, Hunter J, Kervella D, Timsit MO, Badet L, Glemain P, Morelon E, Buron F, Le Quintrec-Donnette M, Pernin V, Ladriere M, Girerd S, Legendre C, Sicard A, Albano L, De Vergie S, Kerleau C, Prudhomme T, Rigaud J, Cantarovich D, Blancho G, Karam G, Giral M, Ville S, Branchereau J. Kidney transplantation from expanded criteria donors: an increased risk of urinary complications - the UriNary Complications Of Renal Transplant (UNyCORT) study. BJU Int 2021; 129:225-233. [PMID: 34114727 DOI: 10.1111/bju.15509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the impact of expanded criteria donors (ECD) on urinary complications in kidney transplantation. PATIENTS AND METHODS The UriNary Complications Of Renal Transplant (UNyCORT) is a cohort study based on the French prospective Données Informatisées et VAlidées en Transplantation/Computerized and VAlidated Data in Transplantation (DIVAT) cohort. Data were extracted between 1 January 2002 and 1 January 2018 with 1-year minimum follow-up, in relation to 44 pre- and postoperative variables. ECD status was included according to United Network for Organ Sharing (UNOS) definition. The primary outcome of the UNyCORT study was the association between the donor's ECD/standard criteria donors (SCD) status and urinary complications at 1 year in uni- and multivariate analysis. Sub-group analysis, stratified analysis on ECD/SCD donor's status and transplant failure analysis were then conducted. RESULTS Between 1 January 2002 and 1 January 2018, 10 279 kidney transplants in adult recipients were recorded within the DIVAT network. A total of 8559 (83.4%) donors were deceased donors and 1699 (16.6%) were living donors (LD). Among donation after circulatory death (DCD) donors, 224 (2.85%) were uncontrolled DCD and 93 (1.09%) were controlled DCD donors. A total of 3617 (43.9%) deceased donors were ECD. The overall urological complication rate was 16.26%. The donor's ECD status was significantly associated with an increased risk of urological complications at 1 year in multivariate analysis (odds ratio: 1.50, 95% CI 1.31-1.71; P < 0.001) and especially with stenosis and ureteric fistulae at 1 year. There is no association with LD, uncontrolled and controlled DCD. The placement of an endo-ureteric stent was beneficial in preventing urinary complications in all donors and particularly in ECD donors. CONCLUSION The donor's ECD status is associated with a higher likelihood of stenosis and ureteric fistulae at 1 year. Recipients of grafts from ECD donors should probably be considered for closer urological monitoring and systematic preventive measures.
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Affiliation(s)
- Benoit Mesnard
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Maxime Leroy
- Plateforme de Méthodologie et de Biostatistique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - James Hunter
- Nuffield Department of Surgical Science, Oxford, UK
| | - Delphine Kervella
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | | | - Lionel Badet
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | - Pascal Glemain
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | - Fanny Buron
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | | | - Vincent Pernin
- Service de Néphrologie-Soins Intensifs-Dialyse et Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Marc Ladriere
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Sophie Girerd
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | | | | | | | | | - Clarisse Kerleau
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Thomas Prudhomme
- Service Urologie, Andrologie et Transplantation Rénale, CHU de Toulouse, Hôpital Rangeuil, Toulouse, France
| | - Jérôme Rigaud
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Diego Cantarovich
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Gilles Blancho
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Georges Karam
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Simon Ville
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Julien Branchereau
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France.,Nuffield Department of Surgical Science, Oxford, UK.,CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
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12
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Malinzak L, McEvoy T, Denny J, Kim D, Stracke J, Jeong W, Yoshida A. Robot-assisted Transplant Ureteral Repair to Treat Transplant Ureteral Strictures in Patients after Robot-assisted Kidney Transplant: A Case Series. Urology 2021; 156:141-146. [PMID: 34058240 DOI: 10.1016/j.urology.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the use of robotic-assisted transplant ureteral repair (RATUR) for treating transplant ureteral stricture (TUS) in 3 patients who had undergone robot assisted kidney transplant (RAKT). METHOD We reviewed the medical records of 3 patients who experienced TUS after RAKT and who underwent RATUR between 2017 and 2020. The patients' RAKT, post-transplant clinical course, endourological interventions, reoperation, and recovery were assessed. RESULTS All patients diagnosed with TUS presented with deterioration of kidney function after RAKT. Method of diagnosis included ultrasound, antegrade ureterogram, and CT scan. All 3 patients had a short (<1 cm) area of TUS and underwent RATUR. For 2 patients, distal strictures were bypassed with modified Lich-Gregoir ureteroneocystostomy reimplantation. One patient was treated with pyelo-ureterostomy to the contralateral native ureter. No intraoperative complications, conversions to open surgery, or significant operative blood loss requiring blood transfusion for any patient were observed. Also, no patients had urine leaks in the immediate or late postoperative period. After RATUR, 2 patients developed Clavien grade II complications with rectus hematoma or urinary tract infection. CONCLUSION RATUR is a technically feasible operation for kidney transplant patients with TUS after RAKT. This procedure may provide the same benefits of open operation without promoting certain comorbidities that may occur from open surgical procedures.
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Affiliation(s)
- Lauren Malinzak
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202.
| | - Tracci McEvoy
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
| | - Jason Denny
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
| | - Dean Kim
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
| | - Joel Stracke
- Mercy Health St. Mary's Hospital, Grand Rapids, MI 49503
| | - Wooju Jeong
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
| | - Atsushi Yoshida
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
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Al-Qaoud TM, Al-Adra DP, Mezrich JD, Fernandez LA, Kaufman DB, Odorico JS, Sollinger HW. Complex Ureteral Reconstruction in Kidney Transplantation. EXP CLIN TRANSPLANT 2021; 19:425-433. [PMID: 33797353 DOI: 10.6002/ect.2020.0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Despite advances in surgical techniques and organ preservation, transplant ureteric strictures remain a common complication in kidney transplantation. A variety of endourological and surgical techniques have been utilized; however, there is a lack of consensus on the optimal modality in dealing with these complex cases. MATERIALS AND METHODS We present challenging ureteral reconstruction cases after failed attempts at ureteral dilatation, failed conventional open repairs, and/or with bladder dysfunction. RESULTS All renal allografts were salvaged by successful use of bladder Boari flap and intestinal segment interpositions/diversions. CONCLUSIONS Operative repair remains the most durable and successful approach, and minimally invasive options should be reserved for nonsurgical candidates, with consideration of a single attempt in patients with early, distal, short (<2 cm), nonischemic strictures.
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Affiliation(s)
- Talal M Al-Qaoud
- From the Department of Surgery, Division of Transplantation, University of Wisconsin, Wisconsin, USA.,From the Department of Urology, University of Wisconsin, Madison, Wisconsin, USA
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14
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Liu G, Wang X, Huang H, Wang R, Peng W, Chen J, Wu J. Perfect outcome of kidney recipients with ureteral stenosis after treatment with open surgery under magnetic resonance urography localization. Transl Androl Urol 2021; 10:1160-1169. [PMID: 33850751 PMCID: PMC8039615 DOI: 10.21037/tau-20-1404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To evaluate the outcome of kidney recipients with ureteral stenosis after treatment with open surgery under magnetic resonance urography (MRU) localization. Methods We assessed 2,256 consecutive kidney transplant recipients between October 2010 and December 2018. Ureteral stenosis was detected by ultrasound, confirmed and positioned by Magnetic Resonance Urography. All patients underwent open ureteral reconstruction. The ureteral stenosis was located according to the location on the MRU during the operation. Surgical complications and recurrence rate were recorded in the stenosis group. Outcomes were compared with those of a matched control group of transplant recipients with no history of ureteric stenosis. Results The incidence of ureteral stenosis in our center was 3.1% (70/2,256). Sixty-four cases (91.4%) were confirmed to have distal stenosis and were reconstructed with ureterovesical re-implantation; six cases (8.6%) were confirmed to have mid-distal stenosis and were subjected to ureteroureterostomy with the use of native ureter. The overall success rate was 100% and the graft function was salvaged in all cases. There was no recurrence of stenosis after a mean follow-up of 38.9±26.3 months. The complication rate was 5.7%. The 110-month graft survival and patient survival were not significantly different between the stenosis and control groups.Conclusions: MRU is an effective method for non-invasive and accurate diagnosis of ureteral stenosis in kidney transplant recipients. Open ureteral reconstruction surgery under MRU localization for treatment of ureter stenosis after kidney transplantation had a high success rate, low recurrence rate and high safety.
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Affiliation(s)
- Guangjun Liu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Xuliang Wang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Hongfeng Huang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Rending Wang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Wenhan Peng
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Jianyong Wu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
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15
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Irdam GA, Sutojo B, Raharja PAR. Risk Factors of Ureteral Stenosis in Kidney Transplant Recipients: A Retrospective Study in National Referral Hospital in Indonesia. Adv Urol 2021; 2021:2410951. [PMID: 33510785 DOI: 10.1155/2021/2410951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/01/2020] [Accepted: 12/31/2020] [Indexed: 01/03/2023] Open
Abstract
Ureteral stenosis is one of the most common urological complications following kidney transplantations. It is occurred in 2–10% of patients and poses a significant problem to the patients as it may lead to permanent damage to renal damage. Identification of risk factors is important to prevent the incidence of ureteral stenosis. Thus, we aim to determine the risk factors of ureteral stenosis in the Indonesian population. This is a retrospective analysis of 487 kidney transplant patients performed in Cipto Mangunkusumo Hospital between 2014 and 2018. We collected and compared donor and recipient demography data in recipients who developed ureteral stenosis and recipients who did not develop ureteral stenosis. Ureteral stenosis was defined as the presence of hydronephrosis from ultrasound and increased number of serum creatinine. The overall incidence of ureteral stenosis post-kidney transplantation in our center is 6.6% (32 from 487 patients) from January 2014 until June 2018. We found that older donor and recipient age more frequent in developing ureteral stenosis post-kidney transplantation (p < 0.001). We also found that donors with number of arteries more than 2 (p < 0.001) and prolonged warm ischemic time (p < 0.05) are more frequently to develop ureteral stenosis post-kidney transplantation. There is no association between type II diabetes mellitus and hypertension with ureteral stenosis in this study. Donor age, recipient age, donor number of arteries more than 2, and prolonged warm ischemia time are associated with ureteral stenosis after kidney transplantation.
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Angelico R, Pellicciaro M, Venza F, Manzia T, Cacciola R, Anselmo A, Toti L, Monaco A, Iaria G, Tisone G. Urological Complications in Kidney Transplant Recipients: Analysis of the Risk Factors and Impact on Transplant Outcomes in the Era of “Extended Criteria Donors”. Transplantology 2021; 2:22-36. [DOI: 10.3390/transplantology2010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Urological complications (UC) following kidney transplantation (KT) are associated with increased morbidity. The aim of this study is to evaluate the risk factors for UC in the era of “extended criteria donors” (ECD) and their impact on patient and graft survivals. A retrospective monocentric study of all patients undergoing KT from 2010 to 2019 with a follow-up ≥30 days was performed. Out of 459 patients (males: 296 (64.5%); age: 57 (19–77) years) enrolled, 228 (49.7%) received ECD organs, moreover, 166 (67.2%) grafts had a cold ischemia time ≥10 h. UCs were reported in 32 (7%) patients. In 21 (65.6%) cases UC occurred within 3 months post-KT and 24 (5.2%) were associated with early urinary tract infection (UTI). The overall 5 year patient and graft survival rates were 96.5% and 90.6%, respectively. UC decreased graft survival (UC-group: 75.0% vs. noUC-group: 91.8%, p < 0.001), especially if associated with early UTI (UC-group: 71.4% vs. noUC-group: 77.8%, p < 0.001). At multivariate analysis, early UTI after KT (OR: 9.975, 95%-IC: 2.934–33.909, p < 0.001) and delayed graft function (DGF) (OR: 3.844, 95%-IC: 1.328–11.131, p: 0.013) were significant risk factors for UC, while ECD graft did not increase the risk of post-transplant UC. ECD grafts are not associated with UC. DGF and early UTI post-KT increase the risks of UC and reduce graft survival in the long-term. Therefore, aggressive management of early post-transplant UTI and strategies to reduce DGF incidence, such as machine preservation, are essential to prevent UC after KT.
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17
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Irdam GA, Raharja PAR, Sutojo B, Situmorang GR. Predictive Model of Ureteral Obstruction of Allograft Kidney Following Living Donor Kidney Transplantation. Transplant Proc 2020; 53:1064-1069. [PMID: 33248722 DOI: 10.1016/j.transproceed.2020.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/25/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ureteral obstruction is one of the most frequent urologic complications of kidney transplantation. This study aimed to analyze independent factors that contribute to ureteral obstruction following kidney transplantation and develop predictive models form those factors. METHODS As many as 545 kidney transplantations were analyzed. Patients underwent transplantation between January 2014 and December 2018. Logistic regression analysis was used to develop the predictive model. Both donor and recipient demographic characteristics and operative parameters were analyzed and presented. RESULTS There were 37 (6.8%) subjects who developed ureteral obstruction. The independent risk factors for ureteral obstruction were multiple allograft renal arteries, older donor ages (>38 years), and older recipient age (>60 years). From the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve of the predictive model was 0.843 (P < .001). Subjects with >2 renal allograft arteries, recipient age >60 years, and donor age >38 years had 83.8% probability of developing ureteral stenosis after kidney transplantation. CONCLUSION Donor age, recipient age, and multiple renal arteries were independent risk factors of graft ureteral obstruction. Probability of developing ureteral obstruction should be considered pre-operatively in our population, using the proposed predictive model.
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Affiliation(s)
- Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Putu Angga Risky Raharja
- Department of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bobby Sutojo
- Department of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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18
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Bruintjes MHD, d'Ancona FCH, Zhu X, Hoitsma AJ, Warlé MC. An Update on Early Urological Complications in Kidney Transplantation: A National Cohort Study. Ann Transplant 2019; 24:617-624. [PMID: 31792196 PMCID: PMC6909919 DOI: 10.12659/aot.920086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
<strong>BACKGROUND</strong> This study aimed to provide an update on the occurrence of early urological complications in living-donor and deceased-donor kidney transplantation (KTX). <strong>MATERIAL AND METHODS</strong> Data on all kidney transplant recipients in the Netherlands between January 2005 and December 2015 were retrieved from the prospectively collected Dutch National Organ Transplant Registry Database (NOTR). We assessed the incidence of major urological complications (MUCs) within 3 months after KTX, defined as urinary leakage and ureteral obstruction. Outcomes of living donor and deceased donor kidney transplants were compared. We performed regression analysis to identify predictive factors of urological complications and studied the influence of early urological complications on graft and patient survival. We performed an additional sub-study to explore the influence of preservation of the peri-ureteric connective tissue in living-donor KTX on the occurrence of urological complications. <strong>RESULTS</strong> Among 3329 kidney transplant recipients, urological complications occurred in 208 patients (6.2%) within 3 months after surgery. There were no significant differences in complication rates between recipients from living donors and deceased donors. Multiple regression analysis showed that older donor age and previous cardiac events of the recipient were predictors for the development of urological complications. Graft and patient survival were not affected by early MUCs. The additional sub-study showed that preservation of peri-ureteric tissue within living-donor KTX was not independently associated with urological complications. <strong>CONCLUSIONS</strong> Many living- and deceased-donor KTX recipients have early urological complications. MUCs did not affect long-term graft or patient survival.
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Affiliation(s)
- Moira H D Bruintjes
- Department of Surgery, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands.,Department of Urology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Frank C H d'Ancona
- Department of Urology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Xiaoye Zhu
- Department of Urology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
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19
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Abstract
Urologic complications of renal transplant occur commonly and can have significant impact on graft function, survival, and patient morbidity. This review examines the prevalence of urologic complications, risk factors, diagnosis and options for management of the most common urologic complications.
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Affiliation(s)
- Hannah R Choate
- Presbyterian Transplant Services, Presbyterian HealthCare Services, Albuquerque, NM, USA
| | - Laura A Mihalko
- Division of Urology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Bevan T Choate
- Department of Urology, Raymond G. Murphy VA Health Medical Center, Albuquerque, NM, USA
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20
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Abstract
The emergency department (ED) is an increasingly important site of care for patients who have undergone solid organ transplantation or hematopoietic cell transplantation. It is paramount for emergency physicians to recognize infections early on, obtain appropriate diagnostic testing, initiate empirical antimicrobial therapy, and consider specialty consultation and inpatient admission when caring for these patients. This review provides emergency physicians with an approach to the assessment of transplant patients' underlying risk for infection, formulation of a broad differential diagnosis, and initial management of transplant infectious disease emergencies in the ED.
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