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Evaluation of Technical Bladder Complications in Kidney Transplantation Recipients with a Prolonged Dialysis History

S. M. Zielsdorf, K. Kushwaha, C. Goldbeck, S. Martin, Y. Kwon, K. Etesami, J. Kim, J. Emamaullee, S. Zielsdorf

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 Name: Kidney Technical

Session Type: Poster Abstract

Date: Monday, June 6, 2022

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 &gt8 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.

Patient Demographics
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
Post-KT Complications
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)
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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 May 28, 2025.

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