Reduced Surgical Complications After Deceased-Donor Kidney Transplantation Using Inverted Allograft and Ultrashort Ureteroureterostomy: A Single-Center Experience

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-07-28 DOI:10.1111/ctr.70235

Rafael Azevedo Foinquinos, Ana Luiza Souza-Leão, Ilan Cubits Kyrillos Oliveira Capela, Thales Paulo Batista, Maria Julia Gonçalves Mello, Cristiano Souza Leão

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Abstract

Objective

To describe the outcomes of combined inverted renal grafts and ureteroureterostomy as the primary operative approach for kidney transplantation (KTx).

Patients and Methods

This case series included adult patients who consecutively underwent deceased-donor KTx for end-stage kidney disease at our center between January 2019 and June 2022. All patients received inverted KTx combined with ultrashort anisoperistaltic end-to-side ureteroureterostomy, without ureteral stenting. Descriptive analysis focused on the major perioperative outcomes within 90 days post-transplantation.

Results

Cohort analysis of 211 patients revealed major postoperative complications requiring reoperation in 15 patients (7.11%). Reoperations for urological reasons included four patients (1.90%) with ureteral stricture and ureteral fistula in two patients each (0.95%). Ureteral strictures were managed with pyeloureterostomy, and ureteral fistulas were treated with end-to-end ureteral re-anastomosis, double-j stenting, JP drain placement, or pyeloureterostomy. Non-urological complications leading to reoperation included peri-graft collections and infections such as surgical hematoma (1.42%), deep surgical infection (1.90%), and wound dehiscence (1.90%). Three patients (1.42%) ultimately underwent transplantectomy because of graft loss after severe infection in two patients (0.95%) and acute rejection plus infection in one patient (0.47%). All the remaining patients were treated with surgical exploration, evacuation/irrigation, and wound closure. Vascular complications occurred in one patient with an arterial stricture (0.47%). Delayed graft function was found in 82.9% of the patients, with 95.26% achieving resolution within 4 weeks post-transplantation.

Conclusions

Inverted KTx combined with ultrashort end-to-side ureteroureterostomy is a feasible and safe technique with low rates of urological and vascular complications in our experience. To our knowledge, this is the largest case series using this combined surgical approach as the primary technique for deceased-donor KTxs.

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采用反向异体移植和超短输尿管输尿管造口术减少死亡供体肾移植术后的手术并发症：单中心经验

目的探讨逆行肾移植联合输尿管输尿管造口术作为肾移植（KTx）的主要手术方式的效果。患者和方法本病例系列包括2019年1月至2022年6月期间在我们中心连续接受终末期肾病死亡供体KTx治疗的成年患者。所有患者均行逆行KTx联合超短异径输尿管端侧输尿管造口术，无输尿管支架置入。描述性分析侧重于移植后90天内的主要围手术期结果。结果211例患者中有15例（7.11%）出现术后重大并发症，需再次手术。泌尿外科原因再手术输尿管狭窄4例（1.90%），输尿管瘘2例（0.95%）。输尿管狭窄采用输尿管输尿管造口术治疗，输尿管瘘采用输尿管端到端再吻合、双j支架置入、JP引流管置入或输尿管输尿管造口术治疗。导致再次手术的非泌尿系统并发症包括移植物周围收集和感染，如手术血肿（1.42%）、深部手术感染（1.90%）和伤口裂开（1.90%）。2例（0.95%）患者因严重感染后移植物丢失，1例（0.47%）患者因急性排斥反应合并感染后移植物丢失，最终行了移植手术（1.42%）。其余患者均行手术探查、引流/冲洗和伤口愈合。1例动脉狭窄并发血管并发症（0.47%）。82.9%的患者出现移植物功能延迟，95.26%的患者在移植后4周内恢复。结论根据我们的经验，倒置KTx联合超短输尿管端侧输尿管造口术是一种安全可行的技术，泌尿系统及血管并发症发生率低。据我们所知，这是使用这种联合手术方法作为死亡供体KTxs主要技术的最大病例系列。

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.