Outcomes and Surgical Complications in Kidney Transplantation

F Reyna-Sepúlveda, A Ponce-Escobedo, A Guevara-Charles, M Escobedo-Villarreal, E Pérez-Rodríguez, G Muñoz-Maldonado, M Hernández-Guedea, F Reyna-Sepúlveda, A Ponce-Escobedo, A Guevara-Charles, M Escobedo-Villarreal, E Pérez-Rodríguez, G Muñoz-Maldonado, M Hernández-Guedea

Abstract

Background: Kidney transplantation is the most cost-effective therapy for end-stage renal disease. Post-operative complications account for 15%-17% of all cases and are associated with significant morbidity. Currently 4.8% of post-transplantation patients have returned to dialysis. Our center's main transplant origin is cadaveric donation.

Objective: To review surgical complications of kidney transplantation over the past 5 years.

Methods: This was an observational descriptive study that included all patients from 2011 to 2015.

Results: A total of 55 cases were reviewed. Diabetic nephropathy was the etiology in 30.9% of cases. Post-surgical complications occurred in 12.7% of patients with a post-operative mortality of 4%. Graft survival at 1 year was 82.4% with a 91% 1-year patient survival.

Conclusion: Early identification and treatment of surgical complications are critical for patient and graft survival. Complications are low but significant.

Keywords: Graft survival; Intraoperative complications; Kidney failure; Kidney transplantation; Morbidity; chronic.

Figures

Figure 1
Figure 1
Infected surgical wound before (left) and after (right) vacuum-assisted closure

References

    1. Merrill JP, Murray JE, Harrison JH. Successful homotransplantations of the human kidney between identical twins. JAMA. 1956;160:277.
    1. Kobayashi K, Censullo ML, Rossman LL. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 2007;27:1109.
    1. Saidi R, Kawai T, Kennealey P. Living donor kidney transplantation with multiple arteries: recent increase in modern era of laparoscopic donor nephrectomy. Arch Surg. 2009;144:472.
    1. Cecka JM. The OPTN/UNOS renal transplant registry. In: Cecka JM, Terasaki PI, editors. Clinical transplants. Los Angeles (Calif): UCLA tissue typing laboratory; 2005. pp. 1–16.
    1. Amend WCJ, Vincenti F, Tomlanovich SJ. The first three postransplant months. In: Danovitch GM, editor. Handbook of kidney transplantation. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. pp. 212–23.
    1. Excerpts from the United States renal data base. 2006 annual data report: atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis. 2007;49:S147–S158.
    1. Hashimoto Y, Nagano S, Oshima S, et al. Surgical complications in kidney transplantation: experience from 1200 transplants performed over 20 years at six hospitals in central Japan. Transplant Proc. 1996;28:1465–7.
    1. Eufrásio P, Parada B, Moreira P, et al. Surgical complications in 2000 renal transplants. Transplant Proc. 2011;43:142–4. doi: 10.1016/j.transproceed.2010.12.009.
    1. Patel NH, Jindal RM, Wilkin T, et al. Renal arterial stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology. 2001;219:663–7.
    1. Libicher M, Radeleff B, Grenacher L, et al. Interventional therapy of vascular complications following renal transplantation. Clin Transplant. 2006;20:55–9.
    1. Osman Y, Shokeir A, Ali-el-Dein B, et al. Vascular complications after live donor renal transplantation: study of risk factors and effects on graft and patient survival. J Urol. 2003;169:859–62.
    1. Obed A, Uihlein DC, Zorger N, et al. Severe renal vein stenosis of a kidney transplant with beneficial clinical course after successful percutaneous stenting. Am J Transplant. 2008;8:2173–6.
    1. Merrill JP, Murray JE, Harrison JH, Guild WR. Successful homotransplantation of the human kidney between identical twins. J Am Med Assoc. 1956;160:277–82.
    1. Melamed ML, Kim HS, Jaar BG, et al. Combined percutaneous mechanical and chemical thrombectomy for renal vein thrombosis in kidney transplant recipients. Am J Transplant. 2005;5:621–6.
    1. Rouvière O, Berger P, Béziat C, et al. Acute thrombosis of renal transplant artery: graft salvage by means of intra-arterial fibrinolysis. Transplantation. 2002;73:403–9.
    1. Giustacchini P, Pisanti F, Citterio F, et al. Renal vein thrombosis after renal transplantation: an important cause of graft loss. Transplant Proc. 2002;34:2126–7.
    1. Sebastià C, Quiroga S, Boyé R, et al. Helical CT in renal transplantation: normal findings and early and late complications. Radiographics. 2000;21:1103–17.
    1. Emiroglu R, Karakayali H, Seumis S, et al. Urologic complications in 1275 consecutive renal transplantations. Transplant Proc. 2001;33:2016–7.
    1. Starzl TE, Groth CG, Putman CW, et al. Urological complications in 216 human recipients of renal transplants. Ann Surg. 1970;172:1–22.
    1. Shoskes DA, Hanbury D, Cranston D, Morris PJ. Urological complications in 1000 renal transplant recipients. J Urol. 1995;153:18–21.
    1. Moreira P, Parada B, Figueiredo A, et al. Comparative study between two techniques of ureteroneocystostomy: Taguchi and Lich-Gregoir. Transplant Proc. 2007;39:2480–2.
    1. Moreira P, Parada B, Figueiredo A, et al. Comparative study between two techniques of ureteroneocystostomy: Taguchi and Lich-Gregoir. Transplant Proc. 2007;39:2480–2.
    1. Lechevallier E, Bretheau D, Berland Y, et al. Outcome of kidney transplants with multiple arteries. Prog Urol. 1995;5:370–6.
    1. Coen LD, Raftery AT. Anatomical variations of the renal arteries and renal transplantation. Clin Anat. 1992;5:425–32.
    1. Troppmann C, Wiesmann K, McVicar JP, et al. Increased transplantation of kidneys with multiple renal arteries in the laparoscopic live donor nephrectomy era: surgical technique and surgical and nonsurgical donor and recipient outcomes. Arch Surg. 2001;136:897–907.
    1. El-Sherbiny M, Abou-Elela A, Morsy A. The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation. Int Urol Nephrol. 2008;40:283–7.
    1. Wolters HH, Schult M, Heidenreich S, et al. The anastomosis between renal polar arteries and arterial epigastrica inferior in kidney transplantation: an option to decrease the risk of ureter necrosis? Transpl Int. 2001;14:442–4.
    1. Berardinelli L. Technical problems in living donor transplantation. Transplant Proc. 2005;37:2449–50.
    1. Ghazanfar A, Tavakoli MR, Zaki , et al. The Outcomes of Living Donor Renal Transplants With Multiple Renal Arteries: A Large Cohort Study With a Mean Follow-Up Period of 10 Years. Transplantation Proceedings. 2010;42:1654–8.

Source: PubMed

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