Introduction: Urological complications are common after kidney transplantation. The aim of this study is to evaluate the effect of ureteral length on ureter strictures or urinary leakage.

Methods: Data were collected from the INEX registry, a prospective study performed between October 2010 until December 2012, in which 200 consecutive recipients of a living donor kidney transplant were included to compare the intravesical to the extravesical ureteroneocystostomy. Ureteral length was measured in 198 patients and used to divide recipients into 3 categories: 1) Short ureters; <8.9cm, 2) Medium ureters; 9.0-10.9cm and 3) Long ureters; > 11cm. Urological complications between the categories were compared and an univariate risk factor analysis for urological complications was performed.

Results: Fifty recipients were allocated to the short ureter category, 98 to the medium category and 50 recipients to the long ureter category. The mean follow-up of all recipients was 27.3 ± 9.5 months. There was no significant difference in number of PCN placements between the categories. An univariate risk factor analysis for gender, arterial multiplicity and for type of ureteroneocystostomy showed no differences in outcome for the whole group of 198 recipients. However, a subgroup analysis revealed that male recipients in the short ureter category had a significant higher risk for urological complications (p=0.038) as well as recipients in the long ureter category in whom an arterial reconstruction of multiple arteries of the kidney graft was performed (p= 0.043).

Conclusion: Based on our data, we conclude that in case of a male recipient or an arterial reconstruction, ureteral length does matter in terms of urological complications after living donor kidney transplantation.

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