Experiences in Kidney Transplantation With Duplicated Ureters

Donor Kidney With Complete Duplication of Ureter: Is It Safe for Transplantation?

Renal transplantation is the best modality of treatment for patients with end-stage renal disease. Donor shortage remains a substantial problem, for which different strategies are employed, including acceptance of marginal donors and donor kidneys with anatomic variations. We performed a successful kidney transplant of a donor kidney that had complete duplication of the ureter. After transplant, the recipient had no urinary complications.

Transplantation of a Kidney With Duplicated Ureter Harvested From a Donor With Vascular Anomaly in the Form of Double Inferior Vena Cava: A Case Report

During the organ procurement procedure, a surgeon encounters anatomic anomalies not very often but also not uncommonly. These changes may put the success of the transplant into question. Despite the thorough diagnosis of the potential donor, these anomalies are often diagnosed during organ donation. In our paper we present a case of kidney transplantation with duplicated ureter. The organ was collected from a donor with duplicated inferior vena cava. After transplantation, the kidney functioned immediately. Taking into consideration the well-being of the recipient, organs with anatomic abnormalities should be carefully considered for transplantation. This is especially important when there is a constant shortage of organs for transplantation.

Urologic Complications After Transplantation of Kidneys With Duplicated Ureter: A Retrospective Study

BACKGROUND

Duplication of ureters is a common anatomic abnormality and occurs in 0.7% to 1% of the general population. In this article we focus on the safety of using of kidneys with complete ureteral duplication, provided no hydronephrosis or ureterocele was present in the donor.

METHODS

From 1998 to March 2018 there were 1965 kidneys transplanted at our institution, including 27 kidneys with duplicated ureter, which corresponds to incidence of 1.4%. Patients' medical records, surgery protocols, and Poltransplant registries were searched for urinary complications.

RESULTS

In the double ureter group, urologic complications occurred in 4 patients (15.4%). Similarly, severe urinary complications developed in 4 patients from the control group (17.4%).

CONCLUSIONS

Transplantation of kidneys with duplicated ureters appears to be a safe and feasible procedure.

Duplicated Ureters in Transplantation-A Single-center, Retrospective Study

BACKGROUND

Kidney transplantation remains the best therapeutic option for chronic renal failure. The objective of the study was to evaluate the impact of ureteral duplication in donor kidneys on transplantation outcome.

METHODS

In this study we performed a retrospective analysis of 75 patients who had undergone renal transplantation. The evaluated parameters included frequency of occurrence and risk of reoperation and graftectomy, mortality, as well as dependency of early and long-term graft function on pyelocaliceal system duplication.

RESULTS

Ureteral duplication was associated with more frequent double J stent catheter implantation (P < .05). There was no relationship detected between ureteral duplication, number of operations performed, and risk of graftectomy (P > .05). Early graft function with 2 ureters was similar to that of grafts with a single pyelocaliceal system. The long-term results were also comparable.

CONCLUSION

Ureteral duplication should not be considered a contraindication for renal transplantation.

Outcome of kidney transplant with double ureter: a multicenter study

OBJECTIVES

Renal transplant with double ureters is uncommon. However, with increasing numbers of en bloc and dual transplants from marginal donors, we frequently observe 2 ureters for implant. The current study reviewed our experience with 76 double-ureter renal transplants.

MATERIALS AND METHODS

We performed a retrospective analysis of renal transplant performed in 2 institutes from 1996 to 2011. We recorded the outcomes of renal transplants with double ureters including complications. We compared outcomes with renal transplants with single ureters.

RESULTS

Irrespective of the technique used for implant, we recorded no significant risk of complications of double, compared with single, ureter renal transplants. There were no significant differences in patient and graft survival.

CONCLUSIONS

We believe that double-ureter transplant does not require additional risk discussion with the recipient because it is safe. However, when ureteral stents are used, we should ensure that a mechanism is in place for both stents to be removed postoperatively.

First report of an unexpected blind-ending duplication of the ureter as a rare pitfall in kidney transplantation

We report on the case of an unexpected blind-ending ureter in a kidney transplant. To our knowledge, this is the first report of a blind-ending ureter in kidney transplantation. The recipient was a 60-year-old woman, with a 6-year history of chronic haemodialysis. During the performance of ureterocystostomy, the ureteric stent could not be placed in the renal pelvis as the ureter, surprisingly, was found as blind-ending in the ureteral sheath. Dissecting the ureteral sheath a second shorter ureter was found and used for ureterocystostomy. The histology reported a normal ureter, which led to a thread of connective tissue. The patient had an uneventful recovery; the creatinine was 1.07 mg/dl at discharge from the hospital. It is mandatory for the transplanting surgeon to be aware of the ureteral variations and the surgeon should be trained in the surgical management of these variations. Accuracy should be ensured when exploring the exact anatomy of the donor organ.

Enquête nationale prospective sur la qualité chirurgicale des greffons rénaux en France. Etude du Comité de Transplantation de l’Association Française d’Urologie

STUDY OBJECTIVE

The objective of this prospective study was to describe the nature of the lesions observed during brain-dead cadavre donor kidney harvesting in France and to identify the risk factors for these lesions.

MATERIAL AND METHODS

A questionnaire elaborated by the AFU Transplantation Committee concerning the quality of kidneys harvested from cadavre donors was sent to all centres performing renal transplantation in France in 2000. This prospective study was conducted over a period of 1 year and concerned the overall multi-organ harvesting procedure based on all data concerning the renal parenchyma, arteriovenous and ureteric characteristics, and the outcome of the transplants.

RESULTS

Twelve centres completed the survey, allowing analysis of the data of 201 donor kidneys. 91% of harvesting surgeons were urologists. Various incidents were reported during 11% of harvesting procedures, but 1/3 of the abnormalities were not recorded by the harvesting surgeon. Isolated kidney harvesting was found to be a risk factor (20% vs 8.6%). The rate of parenchymal abnormalities was 50%, 2/3 of which were related to inadequate removal of perirenal fat. Atheroma was a risk factor for arterial lesions during harvesting (21% vs 6.50). Venous abnormalities were detected in 9% of cases: 89% of them were due to the harvesting procedure and 59% of them were not identified by the harvesting surgeon. The fact of not being a transplant surgeon was a risk factor for venous lesions (21.9% vs 6.5%). 4% of ureteric lesions were observed with no consequence on graft outcome.

CONCLUSION

Adequate removal of perirenal fat before conditioning is not acquired. Isolated kidney harvesting and atheroma were risk factors for parenchymal and arterial lesions, respectively. Venous harvesting anomalies were more frequent among non-transplant surgeons.