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Surgical and urological complications after renal transplantation

Surgical and urological complications after renal transplantation

Urologe Ausgabe A 21(5): 256-264

The incidence, pathogenesis, diagnostic procedures and management of surgical and urological complications observed in 437 [human] consecutive renal transplantations are described. Urinary fistulas (4.3%) and ureteral obstructions (1.8%) were the most frequent urological complications. Prompt diagnosis and correction are mandatory to prevent graft loss and death of the recipient, especially if these conplications are associated with infection. A high incidence of reflux into the graft (37.6%) was detected by routine cysto-urethrogram. A correlation between the incidence of reflux and the number of rejection episodes could be demonstrated; immunological alterations of the transplant ureter may be the main pathogenetic factor of reflux after renal transplantation. Reflux does not seem to be deleterious to graft prognosis, provided there is no subvesical obstruction. The main surgical complications after renal transplantation are lymphoceles (8.2%), renal artery stenoses (6.7%), and spontaneous graft ruptures (4.3%), while wound infections (1.8%) and arterial thromboses and ruptures (0.7 and 0.5%, respectively) are rare complications. Urological and surgical complications can be kept to a minimum by strict adherence to certain principles in pretransplant recipient evaluation, donor nephrectomy (in situ perfusion, en bloc nephrectomy) and the technique of graft implantation. The extravesical technique of uretero-neocystostomy is the procedure of choice for the reconstruction of the urinary tract in renal transplantation.

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