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Surgical Complications after Kidney Transplantation

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Kidney and Pancreas Transplantation

Part of the book series: Current Clinical Urology ((CCU))

Abstract

Surgical complications following renal transplan-tation can occur at any time, and are predominantly related to the transplant wound, vascular anastomoses, or other urologic problems. Surgical complications continue to occur in about 10–20% of transplant recipients, but fortunately, are rarely the cause of allograft loss. Improvements in surgical technique and meticulous attention to both the donor and recipient operations have led to a significant decrease in the rate of surgical complications [1]. Equally important in minimizing the morbidity of transplant surgical complications is anticipation of these problems and prompt treatment when they occur. Perhaps the most significant factor that complicates the outcome of transplant surgical problems is the continuous use of immuno suppression, needed to prevent rejection of the allograft. Therefore in principle, transplant surgical problems should be treated using more conservative methods, which include a more prolonged period of drainage, diversion, suture retention, and the use of nonabsorbable sutures when confronted with these problems. The routine use of broad-spectrum antibiotics beginning in the operating room and the immediate perioperative period has also helped to minimize posttransplant wound infections [2].

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References

  1. Flechner SM, Duclos A. Renal transplantation. In: Montague DK, Angermeier K, Gill IS, Ross JH (eds.). Reconstructive Urologic Surgery: Adult and Pediatric. Oxford, UK: Taylor & Francis 2008:133–142.

    Google Scholar 

  2. Villacian JS, Paya CV. Prevention of infections in solid organ transplant recipients. Transpl Infect Dis 1999;1(4):295–296.

    Article  Google Scholar 

  3. Humar A, Ramcharan T, Denny R, et al. Are wound complications after a kidney transplant more common with modern immunosuppression? Transplantation 2001;72:1920.

    Article  PubMed  CAS  Google Scholar 

  4. Kihara A, Kasamaki S, Kamano T, et al. Abdominal wound dehiscence in patients receiving long-term steroid treatment. J Int Med Res 2006; 34:223–230.

    PubMed  CAS  Google Scholar 

  5. Leibovich SJ, Ross R. The role of the macrophage in wound repair. A study with hydrocortisone and anti-macrophage serum. Am J Pathol 1975; 78:71–100.

    PubMed  CAS  Google Scholar 

  6. Ehrlich HP, Tarver H, Hunt TK. Effects of vitamin A and glucocorticoids upon inflammation and collagen synthesis. Ann Surg 1973;177:222–227.

    Article  PubMed  CAS  Google Scholar 

  7. Akselband Y, Harding MW, Nelson PA. Rapamycin inhibits spontaneous and fibroblast growth factor beta-stimulated proliferation of endothelial cells and fibroblasts. Transplant Proc 1991;23(6):2833–2836.

    PubMed  CAS  Google Scholar 

  8. Humar R, Kiefer FN, Berns H, Resink TJ, Battegay EJ. Hypoxia enhances vascular cell proliferation and angiogenesis in vitro via rapamycin (m-TOR)-dependent signaling. FASEB J 2002;16(8):771–780.

    Article  PubMed  CAS  Google Scholar 

  9. Reinders ME, Sho M, Izawa A, et al. Proinflammatory functions of vascular endothelial growth factor in alloimmunity. J Clin Invest 2003;112(11):1655–1665.

    PubMed  CAS  Google Scholar 

  10. Flechner SM, Zhou L, Derweesh I, et al. The impact of sirolimus, mycophenolate mofetil, cyclosporine, azathioprine, and steroids on wound healing in 513 kidney transplant recipients. Transplantation 2003;76:1729–1734.

    Article  PubMed  CAS  Google Scholar 

  11. Araki M, Flechner SM, Ismail HR, Flechner LM, et al. Posttransplant diabetes mellitus (ptdm) in kidney transplant recipients receiving calcineurin or m-TOR inhibitor drugs. Transplantation 2006;81:335–341.

    Article  PubMed  CAS  Google Scholar 

  12. Lo Monte A, Damiano G, Maione C, et al. Use of intraperitoneal ePTFE gore dual-mesh plus in a giant incisional hernia after kidney transplantation: a case report. Transplant Proc 2009;41:1398–1401.

    Article  PubMed  CAS  Google Scholar 

  13. Shrestha BM, Nathan VC, Delbridge MC, et al. Vacuum-assisted closure (VAC) therapy in the management of wound infection following renal transplant. KUMJ 2007;5:4–7.

    PubMed  CAS  Google Scholar 

  14. Patton JH Jr, et al. Use of human acellular dermal matrix (AlloDerm) in complex and contaminated abdominal wall reconstructions. Am J Surg 2007;193(3):360–363.

    Article  PubMed  Google Scholar 

  15. Pollak R, Veremis SA, Maddux MS, et al. The natural history of and therapy for perirenal fluid collections following renal transplantation. J Urol 1988;140:716–722.

    PubMed  CAS  Google Scholar 

  16. Goel M, Flechner SM, Zhou L, et al. The influence of various maintenance immunosuppressive drugs on lymphocele formation and treatment after kidney transplantation. J Urol 2004;171:1788–1792.

    Article  PubMed  CAS  Google Scholar 

  17. Huber S, Bruns CJ, Schmid G, et al. Inhibition of the mammalian target of rapamycin impedes lymphangiogenesis. Kidney Int 2007;71(8):771–777.

    Article  PubMed  CAS  Google Scholar 

  18. Rashid A, Posen G, Couture R, et al. Accumulation of lymph around the transplanted kidney (lymphocele) mimicking renal allograft rejection. J Urol 1974;111:145.

    PubMed  CAS  Google Scholar 

  19. Silver TM, Campbell D, Wicks JD, et al. Peri-transplant fluid collections. Ultrasound evaluation and clinical significance. Radiology 1981;138:145–151.

    PubMed  CAS  Google Scholar 

  20. Gill IS, Hodge EE, Munch LC. Transperitoneal marsupialization of lymphoceles: a comparison of laparoscopic and open techniques. J Urol 1995;153:706–711.

    Article  PubMed  CAS  Google Scholar 

  21. Chandrasekaran D, Meyyappan RM, Rajaraman T. Instillation of povidone iodine to treat and prevent lymphocele after renal transplantation. BJU Int 2003;91:296.

    Article  PubMed  CAS  Google Scholar 

  22. Chin A, Ragavendra N, Hilborne L, et al. Fibrin sealant sclerotherapy for treatment of lymphoceles following renal transplantation. J Urol 2003;170:380–384.

    Article  PubMed  Google Scholar 

  23. Derweesh IH, Ismail HR, Goldfarb D, et al. Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation. BJU Int 2008;101:1415–1419.

    Article  PubMed  Google Scholar 

  24. Tiong H, Flechner SM, Zhou L, et al. A systematic approach to minimizing wound problems for de novo sirolimus treated kidney transplant recipients. Transplantation 2009;87:296–302.

    Article  PubMed  CAS  Google Scholar 

  25. Pappas P, Constantinides C, Leonardou P, et al. Biopsy-related hemorrhage of renal allografts treated by percutaneous superselective segmental renal artery embolization. Transplant Proc 2006;38:1375–1378.

    Article  PubMed  CAS  Google Scholar 

  26. Dalla Valle R, Capocasale E, Mazzoni M, et al. Embolization of a ruptured pseudoaneurysm with massive hemorrhage following transplantation: a case report. Transplant Proc 2005;37:2275–2277.

    Article  PubMed  CAS  Google Scholar 

  27. Ertuk E, Rubens DJ, Panner B, et al. Automated core biopsy of renal allografts using ultrasonic guidance. Transplantation 1991;5:1311–1315.

    Article  Google Scholar 

  28. Orlando G, Di Cocco P, Gravante G, et al. Fatal hemorrhage in two renal graft recipients with multi-drug resistant Pseudomonas aeruginosa infection. Transpl Infect Dis 2009;11:442–447.

    Article  PubMed  CAS  Google Scholar 

  29. Gorey TF, Bulkey G, Spees EK, et al. Iliac artery ligation: the relative paucity of ischemic sequelae in renal transplant patients. Ann Surg 1979;190:753–758.

    Article  PubMed  CAS  Google Scholar 

  30. Sienko J, Tejchman K, Cnotliwy M, et al. Crossed bypass femoro-femoralis in patient with external iliac artery occlusion in the course of septic hemorrhage after renal graft explantation. Ann Transplant 2006;11:12–14.

    PubMed  Google Scholar 

  31. Friedman G, Meier-Kriesche HU, Kaplan B, et al. Hypercoagulable states in renal transplant candidates: impact of anticoagulation upon incidence of renal allograft thrombosis. Transplantation 2001;72:1073–1078.

    Article  PubMed  CAS  Google Scholar 

  32. Subramaniam M, Edwards R, Osman HY. Revascularization of kidney allograft after renal artery occlusion secondary to angioplasty. Prog Transplant 2007;17:177–179.

    PubMed  Google Scholar 

  33. Harmon WE, Stablein D, Alexander S, et al. Graft thrombosis in pediatric renal transplant recipients: a report of the American Pediatric Renal Transplant Cooperative Study. Transplantation 1991;51:406–411.

    Article  PubMed  CAS  Google Scholar 

  34. Hausmann M, Vorobiov M, Zlotnik M, et al. Increased coagulation factor levels leading to allograft renal vein thrombosis. Clin Nephrol 2004;61:222–224.

    PubMed  CAS  Google Scholar 

  35. Renoult E, Cormier L, Claudon M, et al. Successful surgical thrombectomy of renal allograft vein thrombosis in the early postoperative period. Am J Kidney Dis 2000;35:E21.

    Article  PubMed  CAS  Google Scholar 

  36. Melamed M, Kim HS, Jaar B, et al. Combined percutaneous mechanical and chemical thrombectomy for renal vein thrombosis in kidney transplant recipients. Am J Transplant 2005;5:621–626.

    Article  PubMed  Google Scholar 

  37. Hurst FP, Abbott KC, Neff RT, et al. Incidence, predictors and outcomes of transplant renal artery stenosis after kidney transplantation: analysis of USRDS. Am J Nephrol 2009;30:459–467.

    Article  PubMed  CAS  Google Scholar 

  38. Palleschi J, Novick AC, Braun W, et al. Vascular complications of renal transplantation. Urology 1980;16:61–66.

    Article  PubMed  CAS  Google Scholar 

  39. Aslam S, Salifu MO, Ghali H, et al. Common iliac artery stenosis presenting as renal allograft dysfunction in two diabetic recipients. Transplantation 2001;71:814–817.

    Article  PubMed  CAS  Google Scholar 

  40. Marques M, Prats D, Sanchez-Fuctuoso A, et al. Incidence of renal artery stenosis in pediatric en bloc and adult single kidney transplants. Transplantation 2001;71:164–166.

    Article  PubMed  CAS  Google Scholar 

  41. Mourad G, Ribstein J, et al. Contrasting effects of acute angiotensin converting enzyme inhibitors and calcium antagonists in transplant renal artery stenosis. Nephrol Dial Transplant 1989;4:66–70.

    PubMed  CAS  Google Scholar 

  42. Goel M, La Perna L, Whitelaw S, et al. Current management of transplant renal artery stenosis: clinical utility of duplex Doppler ultrasonography. Urology 2005;66:59–64.

    Article  PubMed  Google Scholar 

  43. Bakker J, Beek FJ, Beutler J, et al. Renal artery stenosis and accessory renal arteries: accuracy of detection and visualization with gadolinium-enhanced breath-hold MR angiography. Radiology 1998;207:497–504.

    PubMed  CAS  Google Scholar 

  44. Loubeyre P, Cahen R, Grozel F, et al. Transplant renal artery stenosis. Evaluation of diagnosis with magnetic resonance angiography compared with color duplex sonography and arteriography. Transplantation 1996;62:446–450.

    Article  PubMed  CAS  Google Scholar 

  45. Prince MR, Zhang H, Morris M, et al. Incidence of nephrogenic systemic fibrosis at two large medical centers. Radiology 2008;248:807–816.

    Article  PubMed  Google Scholar 

  46. Greenstein S, Verstandig A, McLean G, et al. Percu taneous transluminal angioplasty. The procedure of choice in the hypertensive renal allograft recipient with renal artery stenosis. Transplantation 1987;43:29–32.

    Article  PubMed  CAS  Google Scholar 

  47. Bruno S, Remuzzi G, Ruggenenti P. Transplant renal artery stenosis. J Am Soc Nephrol 2004;15:134–141.

    Article  PubMed  Google Scholar 

  48. Valpreda S, Messina M, Rabbia C. Stenting of transplant renal artery stenosis: outcome in a single center study. J Cardiovasc Surg 2008;49:565–570.

    CAS  Google Scholar 

  49. Shames B, Odorico J, D’Alessandro A, et al. Surgical repair of transplant renal artery stenosis with preserved cadaveric iliac artery grafts. Ann Surg 2003;237:116–122.

    Article  PubMed  Google Scholar 

  50. Osman I, Barrero R, Leon E, et al. Mycotic pseudoaneurysm following a kidney transplant: a case report and review of the literature. Pediatr Transplant 2009;13:615–19.

    Article  PubMed  Google Scholar 

  51. Garrido J, Lerma J, Heras M, et al. Pseudoaneurysm of the iliac artery secondary to Aspergillus infection in two recipients of kidney transplants from the same donor. Am J Kidney Dis 2003;41:488–492.

    Article  PubMed  Google Scholar 

  52. Sharron J, Esterl R, Washburn W, Abrahamian G. Surgical treatment of an extrarenal pseudoaneurysm after kidney transplantation. Vasc Endovascular Surg. 2009;43:317–321.

    Article  PubMed  Google Scholar 

  53. Azar G, Zarifian A, Frentz G, et al. Renal allograft rupture: a clinical review. Clin Transplant 1996;10:635–638.

    PubMed  CAS  Google Scholar 

  54. Hochleitner B, Kafka R, Spechtenhauser B, et al. Renal allograft rupture is associated with rejection or acute tubular necrosis, but not with renal vein thrombosis. Nephrol Dial Transplant 2001;16:124–127.

    Article  PubMed  CAS  Google Scholar 

  55. Shahrokh H, Rasouli H, et al. Spontaneous kidney allograft rupture. Transplant Proc. 2005;37:3079–3080.

    Article  PubMed  CAS  Google Scholar 

  56. Regan S, Sethi A, Powelson J, et al. Symptoms related to ureteral stents in renal transplants compared with stents placed for other indications. J Endourol 2009;23:2047–2050.

    Article  PubMed  Google Scholar 

  57. Wilson CH, Bhatti AA, Rix DA, Manas DM. Routine intraoperative ureteric stenting for kidney transplant recipients. Cochrane Database Syst Rev. 2005;(4):CD004925.

    Google Scholar 

  58. Talanow R, Neumann D, Brunken R, et al. Urinary leak after renal transplantation proven by SPECT-CT imaging. Clin Nucl Med 2009;32:883–885.

    Article  Google Scholar 

  59. Saad W, Moorthy M, Ginat D. Percutaneous nephrostomy: native and transplanted kidneys. Tech Vasc Interv Radiol 2009;12:172–192.

    Article  PubMed  Google Scholar 

  60. Alcaraz A, Bujons A, Pascual X, et al. Percutaneous management of transplant ureteral fistulae is feasible in selected cases. Transplant Proc 2005;37:2111–2114.

    Article  PubMed  CAS  Google Scholar 

  61. Campbell S, Streem SB, Zelch M, et al. Percutaneous management of transplant ureteral fistulas: patient selection and long-term results. J Urol 1993;150:1115–1118.

    PubMed  CAS  Google Scholar 

  62. Goldman M, Burleson R, Tilney N, et al. Calyceal-cutaneous fistulae in renal transplant patients. Ann Surg 1976;184:679–681.

    Article  PubMed  CAS  Google Scholar 

  63. Thrasher J, Temple D, Spees E. Extravesical vs. Leadbetter-Politano ureteroneocystostomy: a comparison of urological complications in 320 renal transplants. J Urol 1990;144:1105–1110.

    PubMed  CAS  Google Scholar 

  64. Berger PM, Diamond JR. Ureteral obstruction as a complication of renal transplantation: a review. J Nephrol 1998;11:20–23.

    PubMed  CAS  Google Scholar 

  65. Kazory A, Ducloux D. BK virus-associated urologic complications. Pediatr Transplant 2007;11:821–822.

    Article  PubMed  Google Scholar 

  66. Schiff M, Lytton B. Secondary ureteropyelo stomy in renal transplant recipients. J Urol 1981;126:723–726.

    PubMed  Google Scholar 

  67. Lord RH, Pepera T, Williams G. Ureteroureterostomy and pyeloureterostomy without native nephrectomy in renal transplantation. Br J Urol 1991;67:349–351.

    Article  PubMed  CAS  Google Scholar 

  68. Rajfer J, Koyle M, Ehrlich R, et al. Pyelovesicostomy as a form of urinary reconstruction in renal transplantation. J Urol 1986;136–372.

    Google Scholar 

  69. Jarowenko M, Flechner SM. Recipient ureterocalicostomy in a renal allograft. J Urol 1985;133:844–845.

    PubMed  CAS  Google Scholar 

  70. Von Son W, Hooykaas AP, Sloof M, et al. Vesico-calicostomy as ultimate solution for recurrent urologic complications after cadaveric renal transplantation. J Urol 1986;136:889–890.

    PubMed  Google Scholar 

  71. Streem SB, Novick AC, Steinmuller DR, et al. Long-term efficacy of ureteral dilation for transplant ureteral stenosis. J Urol 1988;140:32–36.

    PubMed  CAS  Google Scholar 

  72. Benoit G, Alexander L, Moukarzed M, et al. Percutaneous antegrade dilation of ureteral strictures in kidney transplants. J Urol 1993;150:37–41.

    PubMed  CAS  Google Scholar 

  73. Penn I, Mackie G, Halgrimson C, et al. Testicular complications following renal transplantation. Ann Surg 1972;176:697–699.

    Article  PubMed  CAS  Google Scholar 

  74. Sankari B, Boullier J, Garvin P. Sclerotherapy with tetracycline for hydroceles in renal transplant patients. J Urol 1992;148:1188–89.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Glickman Urologic and Kidney Institute, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave/Q10, Cleveland, Ohio, 44236, USA

    Stuart M. Flechner (Professor of Surgery)

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  1. Stuart M. Flechner
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Correspondence to Stuart M. Flechner .

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Editors and Affiliations

  1. Glickman Urological & Kidney Institute, Children's Hospital of Cleveland Clinic, Euclid Ave. 9500, Cleveland, 44195, Ohio, USA

    T. R. Srinivas

  2. Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Daniel A. Shoskes

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Flechner, S.M. (2011). Surgical Complications after Kidney Transplantation. In: Srinivas, T., Shoskes, D. (eds) Kidney and Pancreas Transplantation. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-642-9_15

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  • DOI: https://doi.org/10.1007/978-1-60761-642-9_15

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