title: Caliceal fistula formation following renal transplantation: management with partial nephrectomy and ureteral replacement.
abstract: 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.
authors.affiliation: Department of Urology, Hospital Regional de Málaga, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Gutiérrez-Calzada
authors.forename: J
authors.initials: J
authors.lastname: Ramos-Titos
authors.forename: J A
authors.initials: JA
authors.lastname: González-Bonilla
authors.forename: A S
authors.initials: AS
authors.lastname: Garcia-Vaquero
authors.forename: A
authors.initials: A
authors.lastname: Martin-Morales
authors.forename: R
authors.initials: R
authors.lastname: Burgos-Rodríguez
mesh_terms: 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*