Urological complications in renal transplantation. A comparison between living-related and cadaveric grafts.
OBJECTIVE
Since 1989 the percentage of living-related donor renal transplantations has increased considerably at our institution. We compared the incidence of urological complications in the living-related donor transplantation (LRDT) group and the cadaveric donor transplantation (CDT) group.


METHODS
Between September 1989 and September 1994, 534 consecutive patients underwent a renal transplantation. During that period, the percentage of LRDT increased from 10 to 25 (mean: 14.8) per year. In all patients a transvesical ureteroneocystostomy without antireflux mechanism was performed.


RESULTS
A urological complication developed in 64 (11.9%) of the recipients (obstruction in 6.3%; leakage in 5.6%). In 41 (7.7%) patients the complication was transitory and could be managed with minimal invasive measures such as a percutaneous nephrostomy (n = 34), drainage of a paraurethral fluid collection (n = 13), transurethral bladder drainage (n = 3) or a combination of these. In 23 (4.3%) of the recipients a secondary urological intervention such as a pyeloureterostomy (n = 21) or percutaneous dilatation of a ureteral stricture was necessary. The incidence of obstruction was equal in the LRDT and CDT groups, whereas leakage was more frequently encountered in the LRDT group (11.4 vs. 4.6%, p < 0.05). Transplant survival after 1 year was significantly better in the LRDT group than in the CDT group (97 vs. 77%, p < 0.001).


CONCLUSIONS
The risk of leakage is higher in living-related donor kidney transplantations. Urological complications, however, do not impair graft survival.
Cimic
J
J
Department of Urology, University Hospital Nijmegen, The Netherlands.
Meuleman
E J
EJ
Oosterhof
G O
GO
Hoitsma
A J
AJ
D000328:Adult; D002102:Cadaver; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D014019:Tissue Donors; D001748:Urinary Bladder Neck Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery