Caliceal fistula formation following renal transplantation: management with partial nephrectomy and ureteral replacement.
Six patients in this series of 543 renal transplants (1.10%) suffered a post-transplant renal segmental infarct of the donor kidney because of occlusion of an accessory renal artery. Five grafted kidneys had multiple renal arteries. Patients presented with symptoms of a caliceal fistula and were treated by partial (25 to 40%) transplant nephrectomy, followed by closure and tissue coverage with either parietal peritoneum (4 patients) or lyophilized human dura mater sealed with fibrin (2). In 2 cases the renal ischemia and necrosis involved the ureter, and a pyelo-pyelostomy was performed. One patient died of cardiorespiratory complications immediately postoperatively. Five years postoperatively all kidneys functioned well without recurrence of fistula and 5 patients returned to a normal life-style. The combination of radical excision and tissue closure, plus ureteral substitution when needed was an effective treatment that prevented loss of the graft.
Gutiérrez-Calzada
J L
JL
Department of Urology, Hospital Regional de Málaga, Spain.
Ramos-Titos
J
J
González-Bonilla
J A
JA
Garcia-Vaquero
A S
AS
Martin-Morales
A
A
Burgos-Rodríguez
R
R
D005500:Follow-Up Studies; D006801:Humans; D007670:Kidney Calices; D007674:Kidney Diseases / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D009392:Nephrectomy / Q000379:methods; D014513:Ureter / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology*