Date: Monday, May 4, 2015
Session Name: Poster Session C: Surgical Issues/Ureteral Complications
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
INTRODUCTION:Ureteropyelostomy is an alternative for urinary tract reconstruction in kidney transplantation in cases where the graft ureter is not available or the recipient bladder is not considered suitable for a primary reimplantaion. Classically, the ureteropyelostomy is performed in a end to side fashion allowing preservation of the drainage of the native kidney. In order to expand the use of the ureteropyelostomy and to make it technically easier we modified the procedure to a end to end fashion including proximal ligation of the native ureter. This procedure raises concerns regarding hydronephrosis, pain or infection of the native kidney. The objective of this study is to assess the complications after end-to-end ureteropyelostomy with native ureter ligation and the ultimate need for native kidney nephrectomy.
METHODS:From our prospective collected database of kidney transplants we identified all cases of ureteropyelostomy performed from February 2010 to August 2014. The primary variables collected were need for native kidney nephrectomy and urinary tract fistulas. All of the cases were conducted the same way, with end-to-end anastomosis, proximal native ureter ligation and ureteral stent placement. The native nephrectomies in this series was analyzed.
RESULTS:From a total of 3655 kidney transplants performed we identified 360 (9.8%) ureteropyelostomies. Out of the 360 patients, 6 (1.6%) had to undergo native nephrectomy and 13 (3,6%) urinary tract fistulas were identified. Among the patients that underwent native kidney nephrectomy three had ADPKD and residual diuresis higher than 250 ml/day and the procedure was indicated due to mass effect or flank pain. The remaining 3 cases were anuric and the nephrectomy indicated due to pyonephrosis in two patients with neurogenic bladder and on patient with diabetes. The time between the transplant and the native nephrectomy ranged from 3 to 24months.
CONCLUSION:Urinary tract reconstruction with end-to-end ureteropyelostomy and native ureter ligation is a versatile and safe procedure. It allows transplantation even when all the graft ureter is not available. The fistula rate is comparable to direct reimplantation of the graft ureter to native bladder and only 1.6 % of the patients will eventually require a native kidney nephrectomy.
To cite this abstract in AMA style:Marinho H, Leslie B, Neves J, Almeida M, Ximenes S, Aguiar W, Tedesco H, Medina J, Soler R. End-To-End Ureteropyelostomy With Ligation of the Native Ureter in Kidney Transplantation: Is It a Safe Procedure? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/end-to-end-ureteropyelostomy-with-ligation-of-the-native-ureter-in-kidney-transplantation-is-it-a-safe-procedure/. Accessed July 22, 2018.
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