Session Time: 6:00pm-7:00pm
Presentation Time: 6:20pm-6:25pm
*Purpose: Uretero-neocystostomy (UN) is routinely performed in renal transplantation. Few studies of primary uretero-ureterostomy (UU) have been reported, showing its safety and feasibility. If the ureter is inadvertently cut short during procurement, the organ can still be used with UU or uretero-pyelostomy, avoiding discard. We started UU technique in 2016 to avoid the need for secondary UU. The aim of this study was to compare the incidence of urological complications and graft & patient survival between the two techniques.
*Methods: From Jan 2009 to Aug 2020, we studied patients with Kidney (KT), Kidney-Pancreas (KPT), and Liver-Kidney (LKT) transplantation. Exclusion criteria included reflux as the cause of ESRD, en-block-KT, patients lost to followup before 5 years, and graft failure within 10 days. Data was collected on patient demographics, peri-operative findings, incidence of urine leak, stricture and fluid collection, and death-censored 5-year graft & patient survival. Categorical variables with Chi-Square test, continuous variables with Student’s T-test, and survival analysis with Log Rank test were done using SPSS.
*Results: Among 515 patients (KT=405, KPT=91, LKT=19), 190 had UU and 325 had UN. 4 patients were converted to UN intraoperatively due to atrophic ureter. In those who underwent UN, 6 patients required secondary UU. There was no statistically significant difference in incidence of urological complications. Foley catheter was taken out earlier and ureteral stricture developed earlier in UU patients (2.3 ± 1.5 vs 18.0 ± 22.9 months, p-value = 0.03). In KT, OR time was shorter in UU (2:39 vs 2:57, p-value = 0.05), and in KPT, death-censored 5-year graft survival rate was better in UU patients (100% vs 75.5%, p-value = 0.04).
|Total UU (n=190)||Total UN (n=325)||P-Value||KT UU (n=136)||KT UN (n=269)||P-Value|
|Age (Y), mean ± SD||48.5 ± 13.2||47.8 ± 0.52||0.52||49.5 ± 13.7||48.5 ± 12.5||0.42|
|Male, % (n)||61.1 (116)||57.5 (187)||0.43||61.0 (83)||56.9 (153)||0.42|
|Foley Catheter Duration (d), mean ± SD||4.0 ± 2.4||4.9 ± 2.1||0.01||4.0 ± 2.5||4.5 ± 1.5||0.17|
|Incidence of Leak, % (n)||1.6 (3)||0.6 (2)||0.28||2.2 (3)||0.7 (2)||0.21|
|Incidence of Stricture, % (n)||1.6 (3)||2.5 (8)||0.50||0.7 (1)||2.2 (6)||0.28|
|Incidence of Fluid Collection, % (n)||1.6 (3)||0.3 (1)||0.11||2.2 (3)||0.4 (1)||0.08|
|5-Year Death-Censored Graft/Patient Survival, %||96.8/93.2||89.2/92.9||0.49/0.06||95.6/93.4||91.4/92.2||0.46/0.23|
*Conclusions: UU is safe and easy to perform with comparable long-term results and has advantages of shorter OR time, removing Foley catheter earlier, and preventing organ discard and secondary UU.
To cite this abstract in AMA style:Shokouh-Amiri H, Naseer MS, Aultman D, McMillan R, Tandukar S, Siskron FT, Singh N, Zibari G. Primary Uretero-ureterostomy in Renal Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/primary-uretero-ureterostomy-in-renal-transplantation/. Accessed August 3, 2021.
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