title: Reconstruction of ureteral necrosis in kidney transplantation using an ileum interposition.
abstract: OBJECTIVE
  Ureteral necrosis is a serious problem in kidney transplantation. Sometimes re-ureterocystostomy is possible, while other cases require an elaborate reconstruction to maintain kidney function. We report our experience with ileum interposition for ureteral reconstruction.
  
  
  METHODS
  After 9 years of dialysis treatment a 58-year-old patient was grafted using the left kidney of a 59-year-old donor with a cold ischemic time of 9.5 hours. The early postoperative course was uneventful apart from delayed graft function. Immunosuppression consisted of an IL-2-receptor antibody, calcineurin inhibitor, mycophenolate mofetil, and corticosteroids. Discharge serum creatinine was 2.3 mg/dL. In month 4 the patient showed a pararenal urinoma; cystoscopy revealed necrosis of the distal ureter. Operative revision showed urine leakage from the renal pelvis through the urinoma into the bladder. As the whole ureter was necrotic, a re-ureterocystostomy was not possible. The patient's own ureter had been extirpated, and the bladder was too small to do a direct anastomosis between it and the kidney. Consequently, an ileum interposition was performed.
  
  
  RESULTS
  The postoperative course was uneventful. Kidney function was stable with a nadir creatinine concentration of 2.0 mg/dL 18 months' posttransplantation, and 14 months' post ileal interposition the kidney function was still satisfactory, with a creatinine level of 2.0 mg/dL.
  
  
  CONCLUSIONS
  Ureteral necrosis is a serious complication following kidney transplantation. Whenever a re-ureterocystostomy or an uretero-ureterostomy is not possible, the interposition of the ileal segment represented a safe procedure to deal with this problem.
authors.affiliation: Department of General Surgery, University of Münster, Münster, Germany. wolterh@uni-muenster.de
authors.forename: H H
authors.initials: HH
authors.lastname: Wolters
authors.forename: D
authors.initials: D
authors.lastname: Palmes
authors.forename: C F
authors.initials: CF
authors.lastname: Krieglstein
authors.forename: B
authors.initials: B
authors.lastname: Suwelack
authors.forename: L
authors.initials: L
authors.lastname: Hertle
authors.forename: N
authors.initials: N
authors.lastname: Senninger
authors.forename: O
authors.initials: O
authors.lastname: Brinkmann
mesh_terms: D006801:Humans; D007082:Ileum / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis; D019651:Plastic Surgery Procedures; D014513:Ureter / Q000473:pathology* / Q000601:surgery*
chemical_list: D007166:Immunosuppressive Agents