Skip to main content
SpringerLink
Log in

Renal Transplantation: Postoperative Technical Complications

  • Chapter
Abdominal Solid Organ Transplantation

  • 1494 Accesses

Abstract

Lymphocele after renal transplantation has been reported from 0.6 to 18 %. The treatment consists of simple aspiration, external drainage, and marsupialization of the cyst into the peritoneal cavity by standard surgical technique or laparoscopy. Stricture of the ureterovesical junction (UVJ) anastomosis, with reported incidence rates of 2–10 %, is the most frequent urologic complication in kidney allograft recipients. Open surgery has traditionally been used for correction of the obstruction. Development of percutaneous modalities of treatment such as percutaneous nephrostomy (PCN) with low complication rates has altered the approach to ureteral stricture. Urine leakage is usually the result of ureteral necrosis as a consequence of rejection or vascular insufficiency and can be treated by insertion of an indwelling ureteral catheter for 21–60 days without the need for surgery. A urine leak can increase rapidly, and drainage often needs to be performed with ultrasound guidance to relieve compression and urinary ascites. Anterograde pyelography is necessary to depict the site of leak and to plan the appropriate intervention. Small urine leaks may be treated with PCN. Transplant artery stenosis is the most common vascular complication (up to 10 %). When treatment is necessary, percutaneous transluminal angioplasty with or without stent placement is nowadays accepted as the initial treatment of choice. Renal vein thrombosis is an unusual posttransplant complication; it happens in <5 % of patients within the first postoperative week; early recognition is crucial because the allograft may sometimes be salvaged by prompt thrombectomy. Thrombosis of the main renal artery occurs very rarely (<1 % of cases) in the early postoperative period and usually leads to graft loss; early diagnosis and treatment are vital for allograft salvage.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Malovrh M, Kandus A, Butorovic-Ponikvar J, et al. Frequency and clinical influence of lymphoceles after kidney transplantation. Transplant Proc. 1990;22:1423–4.

    CAS  PubMed  Google Scholar 

  2. Schweizer RT, Cho SI, Kountz SL, Belzer FO. Lymphoceles following renal transplantation. Arch Surg. 1972;104:42–5.

    Article  CAS  PubMed  Google Scholar 

  3. Braun WE, Banowsky LH, Straffon RA, et al. Lymphoceles associated with renal transplantation. Report of 15 cases and review of the literature. Am J Med. 1974;57:714–29.

    Article  CAS  PubMed  Google Scholar 

  4. Zincke H, Woods JE, Leary FJ, et al. Experience with lymphoceles after renal transplantation. Surgery. 1975;77:444–50.

    CAS  PubMed  Google Scholar 

  5. Bear RA, McCallum RW, Cant J, et al. Perirenal lymphocyst formation in renal transplant recipients: diagnosis and pathogenesis. Urology. 1976;7:581–6.

    Article  CAS  PubMed  Google Scholar 

  6. Morly P, Barnett E, Belli PRF, et al. Ultrasound in the diagnosis of fluid collections following renal transplantation. Clin Radiol. 1975;26:199–207.

    Article  Google Scholar 

  7. Petrek J, Tilney NL, Smith EH, et al. Ultrasound in renal transplantation. Ann Surg. 1977;185:441–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Langle F, Schurawitzki H, Muhlbacker F, et al. Treatment of lymphoceles following renal transplantation. Transplant Proc. 1990;22:1420–2.

    CAS  PubMed  Google Scholar 

  9. Shaver TR, Swanson SJ, Fernandez-Bueno C, Kocandrle V. The optimal treatment of lymphoceles following renal transplantation. Transpl Int. 1993;6:108–10.

    Article  CAS  PubMed  Google Scholar 

  10. McCullough CS, Soper NJ, Clayman RV, et al. Laparoscopic drainage of a posttransplant lymphocele. Transplantation. 1991;51:725–7.

    Article  CAS  PubMed  Google Scholar 

  11. Ratner LE, Bender JS. A novel approach to the drainage of loculated perirenal allograft lymphoceles. Dual scope laparoscopy. Transplantation. 1994;58:961–4.

    Article  CAS  PubMed  Google Scholar 

  12. Khauli RB, Stoff JS, Lovewell T, et al. Post-transplant lymphoceles: a critical look into the risk factors, pathophysiology and management. J Urol. 1993;150:22–6.

    CAS  PubMed  Google Scholar 

  13. Ward K, Klingensmith III WC, Sterioff S, Wagner HN. The origin of lymphoceles following renal transplantation. Transplantation. 1978;25:346–7.

    Article  CAS  PubMed  Google Scholar 

  14. Koene RA, Skotnicki SH, Debruyne FM. Spontaneous renal decapsulation with excessive fluid leakage after transplantation. NEJM. 1979;300:1030–1.

    Article  CAS  PubMed  Google Scholar 

  15. Madura JA, Dumbar JB, Cerilli GJ. Perirenal lymphocele as a complication of renal transplantation. Surgery. 1970;68:310–3.

    CAS  PubMed  Google Scholar 

  16. Szwed AJ, Maxwell DR, Kleit SA, Hamburger RJ. Angiotensin II, diuretics, and thoracic duct flow in the dog. Am J Physiol. 1973;224:705–8.

    CAS  PubMed  Google Scholar 

  17. Stephanian E, Matas AJ, Gores P, et al. Retransplantation as a risk factor for lymphocele formation. Transplantation. 1992;53:676–8.

    Article  CAS  PubMed  Google Scholar 

  18. Martinez-Ocana JC, Lauzurica R, Castellote E, et al. Adult polycystic kidney disease: a risk factor for lymphocele formation after renal transplantation? Transplant Proc. 1995;27:2246–7.

    CAS  PubMed  Google Scholar 

  19. Pedersen NC, Morris B. The role of the lymphatic system in the rejection of homografts: a study of lymph from renal transplants. J Exp Med. 1970;131:936–69.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Howard RJ, Simmonds RL, Najarian JS. Prevention of lymphoceles following renal transplantation. Ann Surg. 1976;184:166–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Shoskes DA, Hanbury D, Cranston D, Morris PJ. Urological complications in 1,000 consecutive renal transplant recipients. J Urol. 1995;153:18–21.

    Article  CAS  PubMed  Google Scholar 

  22. Jones JW, Hunter DW, Matas AJ. Percutaneous treatment of ureteral strictures after renal transplantation. Transplantation. 1993;55:1193–5.

    Article  CAS  PubMed  Google Scholar 

  23. Lieberman SF, Keller FS, Barry JM, Rösch J. Percutaneous antegrade transluminal ureteroplasty for renal allograft ureteral stenosis. J Urol. 1982;128:122–4.

    CAS  PubMed  Google Scholar 

  24. Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955;157:891–4.

    Article  CAS  PubMed  Google Scholar 

  25. Bhagat VJ, Gordon RL, Osorio RW, et al. Ureteral obstructions and leaks after renal transplantation: outcome of percutaneous antegrade ureteral stent placement in 44 patients. Radiology. 1998;209:159–67.

    Article  CAS  PubMed  Google Scholar 

  26. Swierzewski 3rd SJ, Konnak JW, Ellis JH. Treatment of renal transplant ureteral complications by percutaneous techniques. J Urol. 1993;149:986–7.

    PubMed  Google Scholar 

  27. Alcaraz A, Bujons A, Pascual X, et al. Percutaneous management of transplant ureteral fistulae is feasible in selected cases. Transplant Proc. 2005;37:2111–4.

    Article  CAS  PubMed  Google Scholar 

  28. Loughlin KR, Tilney NL, Richie JP. Urologic complications in 718 renal transplant patients. Surgery. 1984;95:297–302.

    CAS  PubMed  Google Scholar 

  29. Kinnaert P, Hall M, Janssen F, Vereerstraeten P, Toussaint C, Van Geertruyden J. Ureteral stenosis after kidney transplantation: true incidence and long-term follow up after surgical correction. J Urol. 1985;133:17–20.

    CAS  PubMed  Google Scholar 

  30. Oosterhof GO, Hoitsma AJ, Witjes JA, Debruyne FM. Diagnosis and treatment of urological complications in kidney transplantation. Urol Int. 1992;49:99–103.

    Article  CAS  PubMed  Google Scholar 

  31. Schwartz BF, Chatham JR, Bretan P, Goharderakhshan R, Stoller ML. Treatment of refractory kidney transplant ureteral strictures using balloon cautery endoureterotomy. Urology. 2001;58:536–9.

    Article  CAS  PubMed  Google Scholar 

  32. Streem SB, Novick AC, Steinmuller DR, Zelch MG, Risius B, Geisinger MA. Long-term efficacy of ureteral dilation for transplant ureteral stenosis. J Urol. 1988;140:32–5.

    CAS  PubMed  Google Scholar 

  33. Lojanapiwat B, Mital D, Fallon L, et al. Management of ureteral stenosis after renal transplantation. J Am Coll Surg. 1994;179:21–4.

    CAS  PubMed  Google Scholar 

  34. Thomalla JV, Lingeman JE, Leapman SB, Filo RS. The manifestation and management of late urological complications in renal transplant recipients: use of the urological armamentarium. J Urol. 1985;134:944–8.

    CAS  PubMed  Google Scholar 

  35. Kashi SH, Lodge JP, Giles GR, Irving HC. Ureteric complications of renal transplantation. Br J Urol. 1992;70:139–43.

    Article  CAS  PubMed  Google Scholar 

  36. Park SB, Kim JK, Cho KS. Complications of renal transplantation: ultrasonographic evaluation. J Ultrasound Med. 2007;26(5):615–33.

    PubMed  Google Scholar 

  37. Parthipun A, Pilcher J. Renal transplant assessment: sonographic imaging. Ultrasound Clin. 2010;5(3):379–99.

    Article  Google Scholar 

  38. Brown ED, Chen MYM, Wolfman NT, Ott DJ, Watson NE. Complications of renal transplantation: evaluation with US and radionuclide imaging. Radiographics. 2000;20(3):607–22.

    Article  CAS  PubMed  Google Scholar 

  39. Dodd GD, Tublin ME, Shah A, Zajko AB. Imaging of vascular complications associated with renal transplants. Am J Roentgenol. 1991;157(3):449–59.

    Article  Google Scholar 

  40. Hohnke C, Abendroth D, Schleibner S, Land W. Vascular complications in 1200 kidney transplantations. Transplant Proc. 1987;19(5):3691–2.

    CAS  PubMed  Google Scholar 

  41. Taylor KJW, Morse SS, Rigsby CM. Vascular complications in renal allografts: detection with duplex Doppler US. Radiology. 1987;162(1):31–8.

    Article  CAS  PubMed  Google Scholar 

  42. Jordan ML, Cook GT, Cardella CJ. Ten years of experience with vascular complications in renal transplantation. J Urol. 1982;128(4):689–92.

    CAS  PubMed  Google Scholar 

  43. Tublin ME, Dodd GD. Sonography of renal transplantation. Radiol Clin N Am. 1995;33(3):447–59.

    CAS  PubMed  Google Scholar 

  44. Snider JF, Hunter DW, Moradian GP, Castaneda- Zuniga WR, Letourneau JG. Transplant renal artery stenosis: evaluation with duplex sonography. Radiology. 1989;172(3):1027–30.

    Article  CAS  PubMed  Google Scholar 

  45. Kim SH. Vascular diseases of the kidney. In: Kim SH, editor. Radiology illustrated. Philadelphia: WB Saunders; 2003. p. 429–32.

    Google Scholar 

  46. Beecro JR, Rajan DK, Clark TWI, Robinette M, Stavropoulos SW. Transplant renal artery stenosis: outcome after percutaneous intervention. J Vasc Interv Radiol. 2004;15(12):1407–13.

    Article  Google Scholar 

  47. Reuther G, Wanjura D, Bauer H. Acute renal vein thrombosis in renal allografts: detection with duplex Doppler US. Radiology. 1989;170(2):557–8.

    Article  CAS  PubMed  Google Scholar 

  48. Surlan M, Popovic P. The role of interventional radiology in management of patients with end-stage renal disease. Eur J Radiol. 2003;46:96–114.

    Article  CAS  PubMed  Google Scholar 

  49. Vollmer WM, Wahl PW, Blagg CR. Survival with dialysis and transplantation in patients with end-stage renal disease. N Engl J Med. 1983;308(26):1553–8.

    Article  CAS  PubMed  Google Scholar 

  50. Akbar SA, Jafri SZH, Amendola MA, Madrazo BL, Salem R, Bis KG. Complications of renal transplantation. Radiographics. 2005;25(5):1335–56.

    Article  PubMed  Google Scholar 

  51. Rouviere O, Berger P, Beziat C, et al. Acute thrombosis of renal transplant artery: graft salvage by means of intra-arterial fibrinolysis. Transplantation. 2002;73:403–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General and Transplant Surgery Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 9, Bologna, 40138, Italy

    Massimo Del Gaudio MD, PhD, Annalisa Amaduzzi MD, Chiara Zanfi MD, Lorenzo Maroni MD & Matteo Ravaioli MD, PhD

Authors
  1. Massimo Del Gaudio MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annalisa Amaduzzi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chiara Zanfi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lorenzo Maroni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matteo Ravaioli MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Del Gaudio MD, PhD .

Editor information

Editors and Affiliations

  1. Surgery and Transplantation, Sant'Orsola Malpighi Hospital, Bologna, Bologna, Italy

    Antonio Daniele Pinna

  2. Surgery and Transplantation, Sant'Orsola Malpighi Hospital, Bologna, Bologna, Italy

    Giorgio Ercolani

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Del Gaudio, M., Amaduzzi, A., Zanfi, C., Maroni, L., Ravaioli, M. (2015). Renal Transplantation: Postoperative Technical Complications. In: Pinna, A., Ercolani, G. (eds) Abdominal Solid Organ Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-16997-2_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-16997-2_22

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16996-5

  • Online ISBN: 978-3-319-16997-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation