Endourologic management of ureteric complications after live-donor kidney transplantation

Among 620 consecutive live-donor kidney transplants, 40 patients (6.5%) developed ureteric complications in the form of fistula (N = 16) or obstruction (N = 24). Patients with these complications were stratified into two consecutive groups according to the use of graft percutaneous nephrostomy (PCN) in their initial management. Group A was comprised of 17 patients (8 fistulas and 9 obstructions) treated by conventional open surgery without graft PCN. In Group B, 23 patients (8 fistulas and 15 obstructions) were initially treated by graft PCN until resolution of azotemia and control of infection, then treated definitively by endourologic procedures or open surgery. Patients of Group B demonstrated significantly better graft function 2 weeks after treatment, better 1-year graft survival, a shorter hospital stay, and a lower incidence of secondary post-treatment complications. Moreover, in this group of patients, endourologic procedures provided definitive management in 3 of 8 patients with ureteric fistula and in 9 of 15 patients with ureteric obstruction. These data supplement the growing evidence that endourologic techniques are good adjuncts to or substitutes for open surgery in renal allograft recipients with ureteric complications.