Results of surgical revisions for ureteral complications after renal transplantation

Objective. - To analyze the results of surgical revision for ureteral complication (ureteric stenosis or urinary leakage) after renal transplantation over a period of 10 years. Materials and Methods. - We performed a retrospective study on 1313 consecutive kidney transplantations carried out in a University Hospital Center between 2005 and 2014. The data of the patients who developed a ureteral stenosis or a urinary leakage secondary to a renal transplantation were analyzed. Combined organ transplantations (kidney-liver and kidney-pancreas), as well as pediatric transplantations were excluded. Results. - Seventy-six patients (5.8%) had ureteric stenosis or urinary leakage after renal transplantation. Forty-six patients (3.5%) underwent surgical revision: 27 for ureteral stenosis, 19 for urinary leakage. Early success was achieved in 26 patients (56.5%), including 14 ureteric stenosis (51.9%) and 12 urinary leakage (63.2%) (P= 0.45). After a complementary endoscopic or surgical treatment, the final success rate was increased to 73.1% (34 patients): 20 ureteric stenosis (74.1%) and 14 urinary leakage (73.7%) (P= 0.98). There were 2 graft losses (4.3%) and one death (2.2%). The mean glomerular filtration rate estimated by the MDRD was 44.58 mL/min/1.73 m(2) (+14.7) before surgery and 45.37 mL/min/1.73 m(2) (+/- 16.5) 6 months after surgery (P = 0.92). Conclusion. - Although frequently challenging, surgical revisions for ureteral complications after renal transplantation give good results, with a low rate of graft loss and mortality. (C) 2019 Elsevier Masson SAS. All rights reserved.