title: Ureteral complications after hand-assisted laparoscopic living donor nephrectomy.
abstract: BACKGROUND
  Urological complications, namely ureteral leak and obstruction, remain a major source of morbidity after renal transplantation. Given that the existing literature on ureteral complications pertains mostly to deceased as opposed to living donors, we aimed to assess the risk factors for ureteral complications solely after living donor nephrectomy.
  
  
  METHODS
  We identified 480 consecutive cases of renal transplantation after hand-assisted laparoscopic living donor nephrectomy at our institution from January 2008 to February 2013. We determined the incidence of ureteral complications and assessed the association with a number of perioperative factors, including age, sex, race, and body mass index of both the donor and recipient; arterial and ureteral anatomy; procurement by transplant surgeon versus urologist; history of previous renal transplantations; technique of ureteral anastomosis; use of ureteral stent; total ischemia time; serum creatinine on discharge; and need for temporary posttransplant hemodialysis.
  
  
  RESULTS
  Among 480 renal transplantations after living donor nephrectomy, ureteral complications occurred in 18 (3.7%), including ureteral leak in 10 (2.1%) and ureteral stricture in 8 (1.6%). Only two factors were significantly associated with ureteral complications on multivariate analysis: increased donor age and no placement of ureteral stent.
  
  
  CONCLUSIONS
  Ureteral complications of renal transplants after living donor nephrectomy are uncommon. The use of a ureteral stent is protective against ureteral complications and increased donor age is associated with an increased incidence of ureteral complications.
authors.affiliation: 1 Department of Urology, Minia University, Egypt. 2 Department of Surgery, Section of Transplantation Surgery, University of Michigan Health System, Ann Arbor, MI. 3 Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, MI. 4 Department of Urology, University of Michigan Health System, Ann Arbor, MI. 5 Address correspondence to: J. Stuart Wolf Jr, M.D., Department of Urology, University of Michigan, 3875 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0330.
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Gabr
authors.forename: Randall S
authors.initials: RS
authors.lastname: Sung
authors.forename: Milagros D
authors.initials: MD
authors.lastname: Samaniego-Picota
authors.forename: Chang
authors.initials: C
authors.lastname: He
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D015607:Stents; D014517:Ureteral Obstruction / Q000209:etiology*