Elsevier

Transplantation Proceedings

Volume 44, Issue 8, October 2012, Pages 2373-2375
Transplantation Proceedings

Renal transplantation
Complication: Metabolic
Lithiasis in 1,313 Kidney Transplants: Incidence, Diagnosis, and Management

https://doi.org/10.1016/j.transproceed.2012.07.052Get rights and content

Abstract

Background

Renal transplantation remains the optimal treatment of patients with end-stage renal disease. Urinary lithiasis represents an unusual urologic complication in renal transplantation, with an incidence of <1%. Today, recipients of kidneys from deceased donors are more likely to receive grafts with undiagnosed lithiasis, which does not occur in patients from living donors, owing to screening with computerized tomography.

Objective

The aim of this study was to evaluate the incidence, diagnosis, and therapeutic management of renal lithiasis in transplanted kidneys at a single institution.

Methods

We reviewed the medical records for 1,313 patients who underwent kidney transplantation from February 1968 to February 2011.

Results

Among the grafts, 17 patients (1.29%) had nephrolithiasis: 9 women and 8 men. Ages ranged from 32 to 63 years (mean = 45.6 years). Fifteen patients received kidneys from cadaveric and only 2 from living related donors. Two stones, both located inside the ureter, were identified during transplant surgery (11.7%). Three instances of lithiasis were incidentally diagnosed by ultrasound during graft evaluation, within 7 days after surgery (17.6%); all 3 were in the calyces. The 12 remaining patients had the stones diagnosed later (70.58%): 6 in the calyces, 3 in the renal pelvis, and 3 inside the ureter.

Conclusions

Urinary lithiasis is a rare complication in renal transplantation. In most patients the condition occurs without pain. The diagnosis and treatment options for graft urolithiasis are similar to those patients with nephrolithiasis in the general population. Extracorporeal shock wave lithotripsy (ESWL) was the most common treatment method.

Section snippets

Materials and Methods

We retrospectively reviewed the records of 1,313 patients undergoing renal allotransplantation from February 1968 to February 2011. The transplants were performed in the right or left iliac fossa with vascular anastomoses to the iliac artery and vein. Ureteral implantation (ureteroneocystostomy) was performed using the modified extravesical technique of Lich-Gregoir, without routine use of a ureteral catheter. Immunosuppression varied with the transplantation era. For the diagnosis of

Results

Among the 1,313 transplants, 17 (1.29%) showed nephrolithiasis in the renal graft. Nine recipients were female and 8 male. Ages ranged from 32 to 63 years (mean 45.6 years). Fifteen patients received kidneys from cadaveric donors and only 2 from living related donors. Two stones, both located inside the ureter, were identified during transplant surgery (11.7%); 3 cases of lithiasis were incidentally diagnosed by US during graft evaluation before the 7th day after surgery (17.6%); all 3 in the

Discussion

More than one-half of the patients with stones in a kidney transplantation did not show any symptom of pain. The plausible explanation for this observation is denervation of the transplanted graft.2, 5, 10, 11 In some cases, concomitant elevation of serum creatinine should be considered with caution to avoid a mistake episode of acute rejection.4 The presence of an uncomplicated calculus is not a contraindication for surgery; however, when there is associated infection the transplantation

References (19)

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