Stone disease in kidney transplantation

Area of Science:

• Nephrology
• Urology
• Transplantation Medicine

Background:

• Kidney stone disease (calculi) can affect both renal transplant recipients and living donors.
• The presence of stones in donor allografts or de novo formation post-transplant presents unique management challenges.

Purpose of the Study:

• To investigate the causes, diagnosis, and treatment strategies for kidney stone disease in renal transplant recipients and donors.
• To assess the efficacy of various interventions for managing calculi in this specific patient population.

Main Methods:

• Analysis of calculi from five patients undergoing renal transplantation.
• Review of immunosuppressive regimens (tacrolimus/cyclosporine, mycophenolate mofetil, corticosteroids).
• Evaluation of treatment modalities including extracorporeal shock wave lithotripsy (ESWL), pyelotomy, and endourological procedures.

Main Results:

• Stone disease etiology included cadaveric donor-gifted stones (1), de novo formation post-transplant (2), and stones in living related donors (2).
• Living related donor stones were treated with ESWL, with one requiring pyelotomy.
• De novo stones in recipients were linked to urinary infections and double-J (JJ) stents; spontaneous passage occurred after stent removal in one case, while another underwent endoscopic lithotripsy.
• ESWL is effective for medium-sized calculi in transplanted kidneys; JJ stent placement may be necessary for stones >10 mm prior to ESWL.

Conclusions:

• Transplanted allografts may harbor stones more frequently than anticipated, underscoring the importance of preoperative donor imaging.
• Extracorporeal shock wave lithotripsy (ESWL) is a recommended treatment for medium-sized calculi within transplanted kidneys.
• Management of stone disease in transplant patients requires tailored approaches, considering the etiology and potential complications associated with immunosuppression and indwelling devices.