"En bloc" paediatric renal donors into adult recipients -- the Newcastle technique.

Whilst debate still continues about the best use of kidneys from small donors, the techniques used have been varied because of the high vascular thromboses rates and ureteric leak rates. The method described here employs a vessel transposition as described by two German series, but it is combined with an extraperitoneal approach. It is now the method of choice in our unit for such en bloc transplants.

Long-term adult renal graft outcome after ureteric drainage into an augmented bladder or ileal conduit.

Patients with an augmented or diverted urinary system are considered higher risk recipients in view of increased technical problems and infective complications. We studied the long-term renal graft function and survival in patients with a pretransplant ileal conduit or ileal/caecocystoplasty. Between 1986 and 1997, 14 of 1253 (1.1%) renal transplant recipients had their transplant ureters anastomosed into an abnormal urinary tract. These consisted of ten ileal conduits and four ileal/caecocystoplasties. Median follow up was 42 months (range 1-156). All ten ileal conduits were discharged with a functioning graft. There was one graft loss chronic rejection and one cardiac death. The median creatinine level was 130 mmol/l and 50% have a urinary infection. All the patients with an ileal/caecocystoplasty were discharged with a functioning graft and these are still functioning; median creatinine of 132 mmol/l and 75% have a urinary infection. One- and 3-year graft survival was 93% and 86%. We conclude that the long-term outcome of renal transplantation in carefully assessed patients with an abnormal urinary tract is satisfactory despite a high incidence of urinary infection.