title: Complications of ureterovesical anastomosis in adult renal transplantation: comparison of the Lich-Gregoire and the Taguchi techniques.
abstract: BACKGROUND
  Our aim is to identify the incidence of urologic complications in adult renal transplantation comparing two different ureterovesical anastomosis techniques, the Taguchi (T) and Lich-Gregoire (LG).
  
  
  METHODS
  Retrospective analysis of adult renal transplants performed at the MUHC between 2000-2009. Excluded: multi-organ transplants, re-do transplants, variant ureteric anastomosis and patients received grafts from UNOS ECD. 372 patients were analyzed. 209 patients (56%) in the T group and 163 patients (44%) in the LG group. Fisher's exact test was used to compare the groups for urologic complications. A multivariate analysis was performed to identify factors associated with graft rejection and death.
  
  
  RESULTS
  21 patients developed a urinary leak or stricture. A total of 13 patients (3.4%) developed ureteric strictures and 9 (2.4%) patients developed urinary leak with no difference in urinary leak or stricture between both groups (p=1). Hematuria requiring intervention developed in 55 patients. A higher incidence of complicated hematuria in the T group when compared to the LG group (37 vs. 18, p=0.079)). No differences in other ureteric complications between the 2 groups. Delayed graft function OR=3.4 (95% CI=1.8-6.3) and grafts from a deceased donors OR=2.2 (95% CI=1.1-4.5) are factors associated with graft loss. Factors associated with first episode of rejection include delayed graft function OR=2.4 (95% CI=1.3-4.4), and the development of ureteric stricture OR=3.9 (95% CI=1.8-8.7).
  
  
  CONCLUSIONS
  Both techniques can be used interchangeably for adult renal transplantation. T technique is associated with a greater risk of hematuria. Ureteric strictures are associated with a shorter time to first graft rejection.
authors.affiliation: Department of Surgery, Section of Hepatobiliary and Transplant Surgery, Mcgill University, Montreal, Quebec, Canada.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Ameer
authors.forename: Murad
authors.initials: M
authors.lastname: Aljiffry
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jamal
authors.forename: Mazen
authors.initials: M
authors.lastname: Hassanain
authors.forename: Suhail
authors.initials: S
authors.lastname: Doi
authors.forename: Myriam
authors.initials: M
authors.lastname: Fernandez
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cantarovich
authors.forename: Prosonto
authors.initials: P
authors.lastname: Chaudhury
authors.forename: Jean
authors.initials: J
authors.lastname: Tchervenkov
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006417:Hematuria / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology; D001743:Urinary Bladder / Q000601:surgery*