Donor type does not influence the incidence of major urologic complications after kidney transplantation.
BACKGROUND
There has been a marked recent increase in the proportion of kidneys transplanted from live donors (LD) and donors after cardiac death (DCD) compared with donors after brain death (DBD). The purpose of this study was to compare the incidence of major urologic complications (MUCs: urinary leak and ureteric stenosis [US]) in kidney transplants procured from LD, DCD, and DBD and to identify the factors associated with MUCs.


METHODS
We studied 901 consecutive renal transplants (LD: 181, DCD: 198, and DBD: 522) performed in the Cambridge Transplant Centre during 1998 to 2008 by retrieving data from a prospective, cross-audited database, and detailed case note review. An ureteroneocystostomy over a double pigtail ureteric stent was performed in all transplants, and ureteric stents were removed after approximately 6 weeks. All ureteric stenoses were treated by surgical reconstruction.


RESULTS
Three patients developed urine leak, and 21 developed US. There was no significant difference in the incidence of US in kidneys retrieved from LD (2.8%), DBD (1.7%), or DCD (3.5%; P=0.28). Recipients with US had a higher incidence of acute rejection (48% vs. 27%; hazard ratio 3.2, P=0.005) and urinary tract infections before the diagnosis of US (48% vs. 19%; hazard ratio 3.0, P=0.01). The incidence of delayed graft function (38% vs. 26%), cold ischemia times (12.9 vs. 13.5 hr), and graft survival was not significantly associated with US.


CONCLUSIONS
The incidence of MUCs is similar in kidneys transplanted from LD, DCD, and DBD. When complications do occur, they can be treated successfully by surgical reconstruction.
Saeb-Parsy
Kourosh
K
Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom. ks10014@cam.ac.uk
Kosmoliaptsis
Vasilis
V
Sharples
Linda D
LD
Watson
Christopher J
CJ
Clatworthy
Menna R
MR
Taylor
Craig J
CJ
Pettigrew
Gavin J
GJ
Bradley
J Andrew
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D001926:Brain Death; D002648:Child; D003251:Constriction, Pathologic; D003643:Death; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014019:Tissue Donors / Q000145:classification; D006113:United Kingdom; D014513:Ureter / Q000473:pathology / Q000601:surgery; D014570:Urologic Diseases / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult