Reconstruction of Ureteral Necrosis in Kidney Transplantation Using an Ileum Interposition

• Published in: Transplantation proceedings Vol. 38; no. 3; pp. 691 - 692
• Main Authors: Wolters, H.H., Palmes, D., Krieglstein, C.F., Suwelack, B., Hertle, L., Senninger, N., Brinkmann, O.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2006
• Subjects: Humans; Ileum - surgery; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - immunology; Kidney Transplantation - methods; Middle Aged; Necrosis; Reconstructive Surgical Procedures; Ureter - pathology; Ureter - surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2006.01.056

Ureteral necrosis is a serious problem in kidney transplantation. Sometimes re-ureterocystostomy is possible, while other cases require an elaborate reconstruction to maintain kidney function. We report our experience with ileum interposition for ureteral reconstruction. After 9 years of dialysis treatment a 58-year-old patient was grafted using the left kidney of a 59-year-old donor with a cold ischemic time of 9.5 hours. The early postoperative course was uneventful apart from delayed graft function. Immunosuppression consisted of an IL-2-receptor antibody, calcineurin inhibitor, mycophenolate mofetil, and corticosteroids. Discharge serum creatinine was 2.3 mg/dL. In month 4 the patient showed a pararenal urinoma; cystoscopy revealed necrosis of the distal ureter. Operative revision showed urine leakage from the renal pelvis through the urinoma into the bladder. As the whole ureter was necrotic, a re-ureterocystostomy was not possible. The patient’s own ureter had been extirpated, and the bladder was too small to do a direct anastomosis between it and the kidney. Consequently, an ileum interposition was performed. The postoperative course was uneventful. Kidney function was stable with a nadir creatinine concentration of 2.0 mg/dL 18 months’ posttransplantation, and 14 months’ post ileal interposition the kidney function was still satisfactory, with a creatinine level of 2.0 mg/dL. Ureteral necrosis is a serious complication following kidney transplantation. Whenever a re-ureterocystostomy or an uretero-ureterostomy is not possible, the interposition of the ileal segment represented a safe procedure to deal with this problem.