Stone disease in kidney transplantation

The aim of this study was to evaluate etiologic, diagnostic, and management aspects of stone disease in renal transplant recipients and donors. Calculi from five patients were analyzed. The immunosuppressive regimen included tacrolimus or cyclosporine, mycophenolate mofetil, and corticosteroids in all cases. The etiology of the stone disease was cadaveric donor-gifted in one patient and de novo stone formation after transplantation in two patients. Additionally, stone disease was found and treated in living related donors in two patients. The mean follow-up was 32.4 +/- 19.7 months. In the living related donors, stones were initially treated by ESWL. Pyelotomy at the back table during the transplantation was required in one of them. The patient with cadaver-gifted stone was also treated by ESWL. In patients with de novo stone formation after transplantation, the stones were related to urinary infections and foreign body double-j (JJ) stent. A small stone in one of these patients (de novo formation) passed spontaneously after removal of the foreign body. Endoscopical lithotripsy was performed in the other patient. Stones are more frequently transplanted with allografts than expected; therefore, preoperative imaging of the donor is important. ESWL is recommended for medium-sized calculi in transplant kidneys. JJ stent insertion before ESWL might be needed in stones larger than 10 mm.