Evaluation of Technical Bladder Complications in Kidney Transplantation Recipients with a Prolonged Dialysis History
University of Southern California, Los Angeles, CA
Meeting: 2022 American Transplant Congress
Abstract number: 1397
Keywords: Kidney transplantation, Outcome, Risk factors, Surgical complications
Topic: Clinical Science » Kidney » 41 - Kidney Technical
Session Information
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: The kidney transplant (KT) waiting list continues to expand, resulting in prolonged dialysis times of >8 years prior to transplantation in some regions. The relationship between long-term dialysis and urinary tract complications after KT remains largely unexplored. This study aims to evaluate risk factors for post-KT complications in patients with a history of prolonged dialysis.
*Methods: A retrospective cohort study of patients who had been on dialysis ≥8 years and underwent KT at a single institution between 1/2000-7/2020 was conducted. The primary objective was any post-KT complication. Secondary outcomes were categorized by type, including urinary, vascular, and other technical complications.
*Results: Overall, 376 patients met inclusion criteria (Table 1). The population was a mean of 49.5±12.2 years at transplant and 64.9% male. Mean pre-KT dialysis time was 10.2±2.6 years. The majority (65.7%) of study subjects were anuric. Complications were observed in 111 (29.5%) of patients, with urinary tract infections being the most common (Table 2). Across the cohort, Foley catheters remained in place for a median of 4 [3, 5] days. Drains were commonly used (62.8%), for a median of 5 [4, 6] days. Despite prolonged anuria, technical urinary tract complications were rare (3.2%).
*Conclusions: In our large, single center experience with KT in patients with prolonged dialysis and anuria, use of prolonged surgical site drainage and bladder decompression via Foley catheter resulted in a low rate of technical urinary tract complications. Further prospective studies are needed to evaluate the optimal duration of bladder decompression and surgical drain utilization in this high-risk population.
| Total (N=376) | No complications (N=265) | Post-op complications (N=111) | P-value | |
| Age at transplantation (years), mean (SD) | 49.5 (12.2) | 48.6 (12.1) | 51.8 (12.3) | 0.02 |
| Sex (male), N (%) | 244 (64.9) | 175 (66.0) | 69.0 (62.2) | 0.47 |
| Time on dialysis (years), mean (SD) | 10.2 (2.6) | 10.2 (2.7) | 10.1 (2.4) | 0.97 |
| Anuria (yes), N (%) | 247 (65.7) | 172 (64.9) | 75 (67.6) | 0.64 |
| Foley catheter (days), median [IQR] | 4 [3, 5] | 4 [3, 5] | 5 [4, 7] | 0.01 |
| Drain placed at time of KT (yes), N (%) | 236 (62.8) | 167 (63.0) | 69.0 (62.2) | 0.88 |
| Surgical drain in place (days), median [IQR] | 5 [4 6] | 5 [4, 6] | 5 [4, 7] | 0.01 |
| Patients post-KT(N=376)N (%) | |
| Any post-KT complication | 111 (29.5) |
| UrinaryLeakUreteral strictureRetentionUTIRefractory hematuriaRefractory lower GU symptomsOther | 102 (27.1)4 (1.1)8 (2.1)17 (4.5)62 (16.4)4 (1.1)5 (1.3)2 (0.5) |
| VascularVenous (thrombosis or kinking)Arterial (stenosis) | 13 (3.5)6 (1.6)7 (1.9) |
| OtherLymphoceleLarge seroma or abscessBleedingFascial dehiscence | 5 (1.3)5 (1.3)6 (1.6)3 (0.8) |
To cite this abstract in AMA style:
Zielsdorf SM, Kushwaha K, Goldbeck C, Martin S, Kwon Y, Etesami K, Kim J, Emamaullee J, Zielsdorf S. Evaluation of Technical Bladder Complications in Kidney Transplantation Recipients with a Prolonged Dialysis History [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-technical-bladder-complications-in-kidney-transplantation-recipients-with-a-prolonged-dialysis-history/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress