Long-term outcomes and late complications of laparoscopic nephrectomy with renal autotransplantation.
OBJECTIVE
We report long-term outcomes and late complications after laparoscopic nephrectomy with autotransplantation.


METHODS
We retrospectively reviewed clinical data on all patients who underwent laparoscopic nephrectomy with autotransplantation between July 2000 and March 2007. Late complications, ie greater than 6 months, that required surgical intervention were analyzed. Clinical outcomes in patients with primary ureteral stricture disease and oncological outcomes in patients with renal tumors were examined.


RESULTS
Indications for autotransplantation included complex ureteral stricture disease in 15 patients and renal malignancy in 4. Median age at surgery was 48 years (range 25 to 68). Median followup was 29 months. Of the 17 patients with greater than 6 months of followup late complications requiring surgical intervention occurred in 4. Transplant nephrectomy was required in 2 patients in the stricture group. Indications for nephrectomy were nonfunction complicated by pseudoaneurysm in 1 case and chronic loin pain in 1. Another patient had recurrent nephrolithiasis requiring percutaneous nephrolithotomy and in 1 a pseudoaneurysm was managed successfully by endovascular techniques. Two patients in the tumor group had disease progression, which was managed medically.


CONCLUSIONS
Given the complexity and severity of disease that necessitates renal autotransplantation, it is not surprising that additional treatments are required. Patients with primary stricture disease may be at increased risk for vascular aneurysm due to infection and/or inflammation. Tumor progression is possible after ex vivo tumor excision and autotransplantation, especially in patients requiring heroic measures to avoid or delay dialysis. Thus, careful patient selection and vigilant followup are mandatory.
Eisenberg
Michael L
ML
Department of Urology, University of California-San Francisco, San Francisco, California 94143-0738, USA.
Lee
Keith L
KL
Zumrutbas
Ali E
AE
Meng
Maxwell V
MV
Freise
Chris E
CE
Stoller
Marshall L
ML
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*