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Donor kidney lithiasis and back-table endoscopy: a successful combination.
Michaël M E L Henderickx1, Joyce Baard1, Pauline C Wesselman van Helmond1
1Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Acta Chirurgica Belgica
|May 26, 2021
Summary
Ex-vivo ureterorenoscopy successfully removed asymptomatic kidney stones from a donor allograft before transplantation. This technique offers a viable option for managing urolithiasis in potential kidney donors, potentially expanding the donor pool.
Area of Science:
- Nephrology
- Urology
- Transplantation Surgery
Background:
- Urolithiasis in renal allografts is uncommon but poses risks like obstruction, sepsis, and graft loss.
- Managing stones in renal allografts is complex due to anatomical challenges, denervation, and immunosuppression.
Observation:
- A case of asymptomatic nephrolithiasis in a living donor kidney allograft was treated ex-vivo.
- A 5.9 × 5.5 × 5.0 mm stone in the lower pole of the donor kidney was identified via CT scan.
- The decision was made to proceed with kidney procurement and ex-vivo stone removal.
Findings:
- Ex-vivo flexible ureterorenoscopy was performed on the back table before allograft implantation.
- A laser was used to access the stone, which was then retrieved using a basket.
- Post-operative CT scan at one month confirmed no residual stones in the transplanted kidney.
Implications:
- Back-table endoscopy is a feasible technique for managing urolithiasis in renal allografts considered for transplantation.
- Treating donor kidney lithiasis can be a rare but effective method to increase the availability of living donor renal allografts.
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