[Long-term outcome of renal transplantation: impact of surgical complications on graft survival].
OBJECTIVE
To determine the incidence of surgical complications of renal transplantation at one institution, relate this to donor and recipient factors and to long-term graft survival.


METHODS
A consecutive series of 145 renal transplants were audited, and a database of donor and recipient characteristics created for risk-factor analysis. An unstented Barry-Sarramon anastomosis was the most used method of ureteric reimplantation. Lich-Gregoir anastomosis was used in 28.9% of cases. The mean follow-up time was 14.4 ± 6.23 years.


RESULTS
There were 67 surgical complications including ten vascular, 39 urological and 18 parietal complications. Among urological complications, 13 were urinary leaks, four distal ureteric necrosis, 13 symptomatic ureteric reflux, six primary ureteric obstructions, and one ureteric stone at some time after transplantation. The overall incidence of urological complications was 26.2%. There was no association with recipient or donor age, cold ischaemic times before organ reimplantation, dialysis duration before transplantation, operating times, or ureteric stenting. Overall surgical complications had a significant pejorative impact on graft survival (Hazard Ratio [HR]=1.805; P=0.32), but as we studied them separately, we highlighted that in fact only vascular complications had an impact on long-term graft survival (HR=17.442, P<5E-10). There was no association between urological (P=0.566) or parietal (P=0.797) complications and long-term graft outcome.


CONCLUSIONS
The onset of a urological or a parietal complication had no impact in this series on long-term graft survival. Vascular complications dramatically increase the rate of graft loss.
Service d'urologie, CHU Jean-Bernard, 2, rue de la Milétrie, 86000 Poitiers, France. baptiste.tisserand@gmail.com
B
B
Tisserand
B
B
Doré
G
G
Touchard
F
F
Bridoux
J
J
Irani
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000209:etiology / Q000473:pathology; D014517:Ureteral Obstruction / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology; D052878:Urolithiasis / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000209:etiology
D015415:Biomarkers; D003404:Creatinine