title: Ureteric complications in recipients of kidneys from donation after circulatory death donors.
abstract: A large increase in the use of kidneys from donation after circulatory death (DCD) donors prompted us to examine the impact of donor type on the incidence of ureteric complications (UCs; ureteric stenosis, urinary leak) after kidney transplantation. We studied 1072 consecutive kidney transplants (DCD n=494, live donor [LD] n=273, donation after brain death [DBD] n=305) performed during 2008-2014. Overall, there was a low incidence of UCs after kidney transplantation (3.5%). Despite a trend toward higher incidence of UCs in DCD (n=22, 4.5%) compared to LD (n=10, 3.7%) and DBD (n=5, 1.6%) kidney transplants, donor type was not a significant risk factor for UCs in multivariate analysis (DCD vs DBD HR: 2.33, 95% CI: 0.77-7.03, P=.13). There was no association between the incidence of UCs and donor, recipient, or transplant-related characteristics. Management involved surgical reconstruction in the majority of cases, with restenosis in 2.7% requiring re-operation. No grafts were lost secondary to UCs. Despite a significant increase in the number of kidney transplants from DCD donors, the incidence of UCs remains low. When ureteric complications do occur, they can be treated successfully with surgical reconstruction with no adverse effect on graft or patient survival.
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Cambridge Biomedical Research Centre, NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK.
authors.forename: Trina-Jo
authors.initials: TJ
authors.lastname: Mah
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Cambridge Biomedical Research Centre, NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK.
authors.forename: Dermot H
authors.initials: DH
authors.lastname: Mallon
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Cambridge Biomedical Research Centre, NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Brewster
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Cambridge Biomedical Research Centre, NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Saeb-Parsy
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Cambridge Biomedical Research Centre, NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Butler
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Cambridge Biomedical Research Centre, NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK.
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bradley
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Cambridge Biomedical Research Centre, NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK.
authors.forename: Vasilis
authors.identifier: 0000-0001-7298-1387
authors.initials: V
authors.lastname: Kosmoliaptsis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology; D014513:Ureter / Q000473:pathology*; D014570:Urologic Diseases / Q000209:etiology* / Q000473:pathology; D055815:Young Adult
keywords: DCD kidney transplantation; ureteric complications