Strictures and Stones: Ex Vivo Ureteroscopy to Salvage Donor Kidney with Extensive Stone Burden: A Case Report

The waiting list for kidney transplants far exceeds the pool of available donors. A significant population in the United States is living with end-stage renal disease (ESRD) yet many procured donor kidneys are not utilized. Significant renal stone disease has often been a relative contraindication to transplantation and a reason to discard these "high-risk" kidneys due to the possibility of post-transplant complications and suboptimal graft function. Salvaging these kidneys presents a chance to increase the availability of transplantable kidneys and assist with the critical shortage of organs.

We present a case of successful transplantation of a donor kidney with substantial stone burden that underwent ex vivo ureteroscopy with stone extraction and treatment of a ureteral stricture during pre-transplant preparation. Utilizing standard ureteroscopy instruments, we successfully cleared the donor kidney of its renal stone burden.

At the 2- and 12-month marks, the recipient had no radiographic signs of ureteral obstruction or stone recurrence with excellent graft function.

Salvage of a donor kidney with concomitant heavy stone burden and ureteral stricture has not been reported before in the literature. This case report demonstrates that pre-transplant stone extraction with ex vivo ureteroscopy is an effective strategy for salvaging a kidney that would otherwise be discarded.