Donor-gifted allograft urolithiasis: early percutaneous management

To describe our successful early management of donor-gifted nephrolithiasis by percutaneous nephrolithotomy. Donor-gifted nephrolithiasis is a rare and frustrating complication of renal transplantation. In the past, initial conservative management with relief of obstruction and shock wave lithotripsy has been recommended.

We treated 3 cases of donor-gifted cadaveric kidney transplant stones by a percutaneous approach 1 to 2 months postoperatively. Two patients presented with hydronephrosis-associated renal deterioration and febrile urinary tract infection, and the third was diagnosed incidentally on routine postoperative ultrasonography.

Percutaneous nephrolithotomy was performed with ultrasound stone fragmentation after initial nephrostomy tube drainage in 1 patient. In the second patient, the stone was successfully removed in a basket in an antegrade fashion. The third patient's ureteral stone was successfully removed by antegrade ureteroscopy. Postoperatively, no residual stones were noted on nephrostography, and renal function returned to normal. CONCLUSIONS. Post-transplant renal calculi can be managed successfully by percutaneous techniques in the early postoperative period and renal function can be salvaged. Pretransplant renal sonography may be considered to limit donor-gifted calculi.