Urinary Complications and Long-Term Graft Survival After Primary Atypical Ureteral Anastomosis in Live-Donor Kidney Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-07-23 DOI:10.1111/ctr.70244

Mohamed H. Zahran, Mohamed Shehata, Muhammed A. Elhadedy, Ahmed S. El-Hefnawy, Shady A. Soliman, Ahmed A. Shokeir, Yasser Osman, Bedeir Ali-El-Dein

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Abstract

Objectives

To assess the urological complications and long-term renal graft survival after primary atypical ureteral anastomosis (PAUA) and to compare it to the standard ureteral anastomosis technique.

Material and Methods

This is a retrospective analysis of all transplant patients with PAUA between 1976 and 2019. The primary outcome was to compare early (urinary leakage and ureteral obstruction) and delayed urinary complications (ureteral stricture and stones), and febrile UTI to the outcomes using the standard ureteral anastomosis technique (control). The second outcome was to compare the long-term graft function and graft survival between the groups.

Results

PAUA was performed in 73 patients, including 39, 27, and 7 patients with ureteroureterostomy, ureteral anastomosis to an augmented bladder, and an ileal conduit, respectively. The control group included 2961 patients. PAUA had a statistically significant higher incidence of urinary leakage (9.6% vs. 2.4%, p = 0.002), ureteral stricture (4.1% vs. 1.2%, p = 0.03), and febrile UTI (28.8% vs. 4.2%, p < 0.001), with insignificant differences regarding early ureteral obstruction (p = 0.6) and stone disease (p = 0.1). At last follow-up, no statistically significant differences in median serum creatinine or e GFR (p = 0.1) were identified between both groups. The cumulative 1-, 2-, 3-, 5-, and 10-year graft survival were 94% versus 94%, 89% versus 92%, 85% versus 89%, 74% versus 82%, and 53% versus 60% in studied group and control, respectively (HR: 0.9, 95% CI = 0.6–1.2, p = 0.6).

Conclusion

Although kidney transplant patients with PAUA have significantly a higher urinary complication rate than those with a standard ureteral anastomosis technique, they have a comparable cumulative graft survival.

Summary

Primary atypical anastomosis of the kidney transplant ureter into an augmented bladder, native ureter, or ileal loop conduit is associated with higher incidence of urinary leakage, ureteral stricture, and febrile urinary tract infection. However, it has no significant impact on long term graft survival.

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非典型输尿管吻合术在活体肾移植术后的泌尿系统并发症和长期移植存活率

目的探讨原发性非典型输尿管吻合术（paa）术后泌尿系统并发症及移植肾远期存活率，并与标准输尿管吻合术进行比较。材料和方法：对1976年至2019年间所有移植患者的paa进行回顾性分析。主要结局是比较早期（尿漏和输尿管梗阻）和延迟性尿路并发症（输尿管狭窄和结石）以及发热性尿路感染与使用标准输尿管吻合技术（对照组）的结果。第二个结果是比较两组间的长期移植物功能和移植物存活率。结果73例患者行PAUA，其中输尿管输尿管吻合术39例，扩膀胱输尿管吻合术27例，回肠导管吻合术7例。对照组2961例。尿漏（9.6% vs. 2.4%, p = 0.002）、输尿管狭窄（4.1% vs. 1.2%, p = 0.03）、发热性尿路感染(28.8% vs. 4.2%, p <；0.001)，在早期输尿管梗阻（p = 0.6）和结石疾病（p = 0.1）方面差异不显著。最后随访时，两组血清中位肌酐和GFR差异无统计学意义（p = 0.1）。研究组和对照组的累积1、2、3、5和10年移植物存活率分别为94%对94%，89%对92%，85%对89%，74%对82%，53%对60% （HR: 0.9, 95% CI = 0.6 - 1.2, p = 0.6）。结论paa肾移植患者的泌尿系统并发症发生率明显高于标准输尿管吻合术患者，但两者的累积移植存活率相当。肾移植输尿管与扩张膀胱、原生输尿管或回肠袢导管的原发性不典型吻合与尿漏、输尿管狭窄和发热性尿路感染的发生率较高相关。然而，它对移植物的长期存活无显著影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.