ABSTRACT
BACKGROUND: Ureteral obstruction is mainly caused by surgical technic, ischemic, and peripheral lesion compression as well as rejection; in particular, the surgical technic factor is the most important. How to effectively reduce ureteral complications following renal transplantation is significant for prompt diagnosis and clinical treatment.OBJECTIVE: To retrospectively analyze the diagnosis of 23 cases with ureteral complications following renal transplantation, and to summarize pathogeny and preventing management.METHODS: The retrospective analysis was conducted on 23 (1.98%) out of 1 160 cases with ureteral complications following renal transplantation who were selected from General Hospital of Jinan Military Area Command of Chinese PLA from January 1998 to December 2008. In 924 cases of renal transplantation with cadaver kidneys, ureteral stenosis occurred in 18 cases (1.95%), while in 236 cases with relative kidneys, ureteral stenosis occurred in 5 cases (2.12%). A total of 17 cases were performed with ureterovesicostomy; 2 with uretero-autoallergic anastomosis of ureter; 1 with cutaneous ureterostomy; 1 with ureteral liberation, resetting ureteric branch stand; 1 with saccule dilation; 1 with retrograde ureteric branch stand under cystoscope. Type-B ultrasonic examination was re-checked to determine pyeloureterectasis following treating ureteral complications.RESULTS AND CONCLUSION: Of the 23 cases, stenosis of ureterovesical junction occurred in 19 cases, necrosis of the ureter on 2 cases, and twisting of ureter graft on 2 cases. Following up was performed after treatment for 3-98 months. In 20 cases, renal pelvis and urinary bladder of transplanted kidney were smooth, and function was recovered remarkably. At 4 days after surgery, serum creatinine level was decreased, and no recurrence was rechecked postoperatively. One patient had skin stoma for 8 years at least postoperatively, and the renal function was still normal. The skin stoma was replaced regularly. Therapeutic effect was poor in a patient with distension and 1 with detaining ureteric branch stand, and patients still had stricture of ureter,which was treated by a surgery. The results demonstrated that the etiology of ureteral obstruction after kidney transplantation was complex, and stenosis of ureterovesical junction was most common. Most of obstruction request surgical management. The graft function and the long-term graft survival were not affected by a correctly treated ureteral obstruction.
ABSTRACT
Objective To summarize the experience on clinical kidney transplantation.Methods 1 053 cases of kidney transplantation were analyzed retrospectively. Factors such as donors conditions, surgical procedure, complications, immunosuppressive therapy, HLA match, and so on were analyzed. Results The 1 , 3 , 5 year survival rate (%) of patient/kidney was 69.3 / 69.0 , 43.0 / 42.6 and 30.7 / 27.8 respectively with the immunosuppressive regime of Aza and Pred before 1988. With the application of CsA after 1989 the survival rate (%) was 93.2 / 92.4 , 79.3 / 78.2 and 66.2 / 64.2 respectively. Acute rejection was the main early complication, 8 % of which could be reversed by prompt therapy. Chronic graft dysfunction was the main complication in the late period, and the main reason for patients' death.Conclusion Good donors conditions and HLA match, reasonable immunosuppressive regime, prevention and prompt therapy of complication after transplantation will improve the patient/kidney survival rate.