Urological Complications in Kidney Retransplanted Patients - A Single Centre Experience.

BACKGROUND: The rate of chronic graft loss after kidney transplant is still considerable despite significant improvements in graft survival and patients may be suitable candidates for retransplantation. However, retransplantation is a high-risk procedure because of limited surgical options, highly sensitized patients and higher rate of graft failure. The aim of this study was to evaluate urological complications of renal retransplantation in our center. SUBJECTS AND METHODS: We evaluated retrospectively the outcomes of kidney retransplantation performed in our center between 1st of July 1997 and 31st of December 2013. A total of 1394 consecutive kidney transplantation were performed and 67 patients were candidates for second transplant. Renal grafts were obtained in 27 cases (40.3%) from cadaveric and in 40 cases (59.7%) from living-related donors. Among these 67 cases of retransplantation, the most common identified causes of end-stage renal disease were chronic glomerulonephritis (31.3%), diabetic nephropathy (7.4%) and systemic lupus erythematosus (4.47%). In 17.9% of retransplanted cases (N=12) recipients were at high immunologic risk compared with 3.99% (N=53) from the first kidney transplantation group (p<.05). Receptor average age was 37.1±9.7 y. o. with a male to female ratio 1.57/1. Donors mean age 47.8±16.2 y. o. with a ratio 1.16/1. RESULTS: The overall incidence of urological complications in kidney retransplanted patients was 7.46% (five cases). Ureteral leakage was the most common complication recorded in three cases (4.48%), all in the first month postoperatively. Other urological complications identified in the retransplanted group were ureteral stenosis (one case- 1.49%) and lymphocele (one case- 1.49%). Conservative treatment (prolonged vesical catheterization) was successful in one case with a small anastomotic fistula. In the other cases of ureteral leakage and stenosis open surgery was needed, consisted in resection of the affected segment and stented ureterocystoneostomy. Lymphocele was successfully treated by percutaneous drainage US guided. CONCLUSIONS: Urological complication rate for kidney retransplantation was considered acceptable. Although the number of patients retransplanted in our center was low, results from this study encourage us to consider retransplantation as the best choice for patients after previous graft failure.