Manual manipulation and ex vivo flexible ureteroscopic lithotripsy to salvage deceased donor kidneys with renal stones: a case series.

Background: Nephrolithiasis is generally considered a relative contraindication for kidney donation. This study aimed to evaluate the feasibility and effectiveness of a surgical technique designed to salvage deceased donor kidneys with renal stones. The technique involves manual manipulation of the recovered kidney combined with flexible ureteroscopic lithotripsy (MM-FURSL) to clear the stones prior to transplantation.

Case presentation: A total of nine kidneys were recovered from six deceased donors. The recipients (66.7% female; mean age 43.9 ± 12.2 years) had been on dialysis for an average of 2.6 years before undergoing renal transplantation with MM-FURSL. Donor kidneys contained 1 to 4 stones each, with a mean maximum stone diameter of 15.1 ± 10.6 mm and an average CT density of 942.0 ± 106.6 HU. The mean warm and cold ischemia times were 5 min and 480 ± 108.2 min, respectively. The average total operative duration was 57.0 ± 63.4 min. The first patient to undergo MM-FURSL had the longest operative and cold ischemia times due to the use of a reusable flexible ureteroscope, which was damaged during the procedure. She was the only patient to experience acute tubular necrosis (ATN), but her creatinine levels normalized within three weeks. No other complications were observed during a mean follow-up period of 11.7 ± 8.2 months.

Conclusion: MM-FURSL is an effective method for removing renal stones in donor kidneys. Short-term outcomes were favorable, suggesting that this technique could be a viable approach to expand the donor pool by salvaging kidneys with nephrolithiasis. However, prolonged cold ischemia time may increase the risk of ATN and should be minimized.