title: Renal transplant lithiasis: analysis of our series and review of the literature.
abstract: OBJECTIVE
  Renal transplant lithiasis represents a rather uncommon complication. Even rare, it can result in significant morbidity and a devastating loss of renal function if obstruction occurs. We present our experience with graft lithiasis in our series of renal transplantations and review the literature regarding the epidemiology, pathophysiology, and current therapeutic strategies in the management of renal transplant lithiasis.
  
  
  METHODS
  In a retrospective analysis of a consecutive series of 1525 renal transplantations that were performed between January 1983 and March 2007, 7 patients were found to have allograft lithiasis. In five cases, the calculi were localized in the renal unit, and in two cases, in the ureter. A review in the English language was also performed of the Medline and PubMed databases using the keywords renal transplant lithiasis, donor-gifted lithiasis, and urological complications after kidney transplantation. Several retrospective studies regarding the incidence, etiology, as well as predisposing factors for graft lithiasis were reviewed. Data regarding the current therapeutic strategies for graft lithiasis were also evaluated, and outcomes were compared with the results of our series.
  
  
  RESULTS
  Most studies report a renal transplant lithiasis incidence of 0.4% to 1%. In our series, incidence of graft lithiasis was 0.46% (n=7). Of the seven patients, three were treated via percutaneous nephrolithotripsy (PCNL); in three patients, shockwave lithotripsy (SWL) was performed; and in a single case, spontaneous passage of a urinary calculus was observed. All patients are currently stone free but still remain under close urologic surveillance.
  
  
  CONCLUSIONS
  Renal transplant lithiasis requires vigilance, a high index of suspicion, prompt recognition, and management. Treatment protocols should mimic those for solitary kidneys. Minimally invasive techniques are available to remove graft calculi. Long-term follow-up is essential to determine the outcome, as well as to prevent recurrence.
authors: 1st Department of Urology, Athens Medical School, Laiko Hospital, Athens, Greece.
authors: Konstantinos G
authors: KG
authors: Stravodimos
authors: Stefanos
authors: S
authors: Adamis
authors: Stavros
authors: S
authors: Tyritzis
authors: Zavos
authors: Z
authors: Georgios
authors: Constantinos A
authors: CA
authors: Constantinides
mesh_terms: D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D016030:Kidney Transplantation / Q000009:adverse effects*; D053040:Nephrolithiasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D009403:Nephrostomy, Percutaneous