Ureteral complications in the renal transplant recipient after laparoscopic living donor nephrectomy.
OBJECTIVE
We report on ureteral and surgical complications in our first 110 consecutive recipients of kidneys procured with laparoscopic living donor nephrectomy (LLDN).


METHODS
The records of all living donor transplants with LLDN performed between February 1999 and December 2004, including 10 pediatric transplants, were reviewed retrospectively. Three urologists performed LLDN using a pure laparoscopic non-hand-assisted transperitoneal technique. Kidney transplantation was performed in a standard fashion. For ureteroneocystostomy, the intravesical Politano-Leadbetter (P-L) technique was used.


RESULTS
Two-year patient and graft survival was 99% and 98%, respectively. Serum creatinine at 12 months was 1.36+/-0.1mg/dl in adult and 0.99+/-0.23 mg/dl in pediatric recipients. Nineteen right donor kidneys were transplanted into adult recipients. Surgical complications included three symptomatic lymphoceles, one peritransplant haematoma and one kinking of a lower pole artery. All five (4.5%) ureteral complications occurred in adult recipients with a mean age of 33.2+/-2.8 years. The incidence of ureteral complications was not clustered around the early phase of our LLDN experience. Of the three (2.7%) patients diagnosed with ureteral obstruction, two required ureteral reimplantation, and one was managed conservatively. Another two patients (1.8%) with a urinary leak received a double J stent and a cystostomy catheter for 3 and 5 months, respectively. Of the five patients with a ureteral complication, three had received a donor kidney with more than one renal artery.


CONCLUSIONS
LLDN combined with the intravesical (P-L) ureteral implantation technique provides excellent graft outcomes with low recipient morbidity. Renal artery multiplicity may increase the risk of ureteral complications.
Fuller
T Florian
TF
Department of Urology, Charité Universitaetsmedizin Berlin Campus Mitte, Berlin, Germany. flofu@yahoo.com
Deger
Serdar
S
Büchler
Annette
A
Roigas
Jan
J
Schönberger
Bernd
B
Schnorr
Dietmar
D
Tüllmann
Max
M
Loening
Stefan A
SA
Giessing
Markus
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D014180:Transplantation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000453:epidemiology* / Q000209:etiology