Urological and vascular complications in 720 renal transplantations – Lessons learned

IntroductionKidney transplants have become common surgical procedures, with thousands performed yearly around the world. Surgical complications in renal transplantation result in significant morbidity to the recipient, with risk of graft loss and mortality.Material and methodsWe retrospectively analyzed 720 cases of renal transplantation done at our center from 1991 to July 2010. The standard techniques of vascular anastomosis and extravesical stented ureteroneocystostomy were used.ResultsMean age at the time of transplantation was 33 years (range 5–67 years) and majority were male (558/720). Live related donor renal transplantation was performed in 684 and deceased donor kidney transplantation in 36 patients. The incidence of ureter related major complication was urinary leak in seven (0.97%) cases and intrinsic ureteral obstruction in two (0.27%) cases. Vascular complications occurred in nine cases including four cases of venous thrombosis of which two could be salvaged. Four grafts were lost due to arterial thrombosis and one due to arterial anastomotic dehiscence.ConclusionRoutine use of ureteric stent seems to reduce the rate of urinary complications. Meticulous tying of all lymphatics tends to reduce the incidence of obstructing lymphocele. Early diagnosis and prompt surgical treatment of urological and vascular complications helps in salvaging the grafts.