title: Impairment of long-term graft function after kidney transplantation by intraoperative vascular complications.
abstract: OBJECTIVE
  Surgical complications in kidney transplantation often demand reoperation and therefore may severely affect graft survival. Major complications can be divided into ureteral and vascular related. Reoperation for ureteral complications is supposed to worsen graft survival, but vascular complications or anastomosis technique has not been evaluated for this issue.
  
  
  METHODS
  Between 1994 and 2004 260 patients underwent kidney transplantation. All ureterovesical junctions were performed in extravesical technique with ureteral stenting in 132/260 (50.7%) patients. Arterial end-to-side anastomosis was performed routinely except for 13/260 (5%) with end-to-end anastomosis. Mean follow-up was 43 months (0-121) including serum creatinine and ultrasound inter alia.
  
  
  RESULTS
  Graft failure rate was 8.1% 12 months and 12.7% 60 months postoperatively. Of the patients, 29/260 (11.5%) underwent reoperation within 30 days after transplantation (stenosis or leakage of the ureterovesical junction: n = 8; vascular complications: n = 10; thrombectomy for graft vein thrombosis: n = 1; evacuation of hematoma: n = 6; nephrectomy for complete graft ischemia: n = 4). Reoperation for vascular-related complications significantly enhances the risk of graft failure (P < 0.05, Cox proportional hazard) compared to urological complications. Arterial end-to-end anastomosis was also found to have a negative impact on graft survival. No correlation between routine ureteral stenting and ureteral stenosis or leakage was found.
  
  
  CONCLUSIONS
  Our data emphasize the importance of vascular complications compared to ureteral ones in kidney transplantation. Resolving 'non-urological' problems successfully, kidney transplantation is a safe procedure in urological hands.
authors.affiliation: Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. guido.fechner@ukb.uni-bonn.de
authors.forename: Guido
authors.initials: G
authors.lastname: Fechner
authors.forename: Carolin
authors.initials: C
authors.lastname: von Pezold
authors.forename: Stefan
authors.initials: S
authors.lastname: Hauser
authors.forename: Thomas
authors.initials: T
authors.lastname: Gerhardt
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Klehr
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology* / Q000601:surgery*