Use of appendix for complete transplant ureteral necrosis.
A 3-yr-old boy with posterior urethral valves underwent cadaveric renal transplant. On the ninth day after transplantation the patient developed a urinary leak, with complete ureteral necrosis. There was insufficient length of undamaged ureter to permit ureteroneocystostomy, unavailability of a native ureter to permit ureteroureterostomy, and an inability to mobilize the transplant kidney or bladder sufficiently to permit direct pyelovesicostomy. As the kidney was otherwise functioning perfectly, we decided to create an appendiceal conduit in the hope of salvaging the patient's renal allograft. At present, 7 months post-transplant, the child is clinically well with a serum creatinine of 0.7 mg/dL. Complete ureteral necrosis is an infrequent but devastating complication following renal transplantation. We report a novel method that allowed an otherwise normally functioning cadaveric graft to be salvaged.
Blaszak
Richard T
RT
Department of Pediatrics and Surgery, Surgical Clinic of Central Arkansas, and St Christopher's Hospital for Children, University of Arkansas for Medical Sciences, AR, USA. blaszakrichardt@uams.edu
Dunn
John F
JF
Finck
Christine M
CM
D001065:Appendix / Q000601:surgery*; D002102:Cadaver; D002675:Child, Preschool; D006801:Humans; D016030:Kidney Transplantation / Q000473:pathology*; D008297:Male; D009336:Necrosis; D014513:Ureter / Q000473:pathology*; D014521:Urethra / Q000002:abnormalities