This will help you learn the most difficult complication in renal transplantation.

1. URINARY LEAKAGE IN
RENAL TRANSPLANTATION
Alp GURKAN, Serdar KACAR, Can VARILSUHA,
Cezmi KARACA, Suleyman TILIF
PRIVATE GOP HOSPITAL, ISTANBUL
PRIVATE KENT HOSPITAL, IZMIR

2. Introduction
Urinary leakage is one of the most difficult
complications to deal with in renal transplantation
procedures. The current rate of ureteral
complications is approximately 10%. Urine leak
following renal transplantation is usually
secondary to ischemic necrosis of the ureter.
We examined the factors effecting urinal leakage in
our renal transplant patients.

3. Patients and Methods
During the time period between Nov. 2005 and
Feb. 2008, 138 renal transplantations have
been performed in Izmir Kent and Istanbul
G.O.P Hospitals.
Double-J catheters were used randomly. All
urinary anastomosis were performed by the
method of Lich-Gregoir.
The factors effecting urinal leakage in our renal
transplant patients were analyzed. Chi-square
and student-t tests were applied for statistical
analysis by using SSPS 11.0

4. Demographics
Deceased donor
44 (31.9%)
Live-related donor
94 (68.1%)
Mean age of donors
45.7
14.06
Mean age of recipients
38.4
11.61
Male/Female of recipients
84/54

5. Laparoscopic donor nephrectomy
47 (50%)
Open donor nephrectomy
47 (50%)
Double-J stent application
81 (58.7%)
Multiple arteries
13 (9.4%)
Acute rejection
16 episodes
Delayed graft function
10 (7.2%)

6. Cold ischemia time (hour)
124
3–5
14
<2
Warm ischemia time (min)
<3
85
2–6
29
7 – 12
17
13 - 24
7

7. Results
2-year patient survival
100 %
2-year graft survival
100 %
Vascular complication
4.3 %
Total Urinary leakage
7.2 %
Urinary leakage with double-J
2.5 %
Urinary leakage without double-J
14 %

8. • Statistically only two factors were found to be
effecting urinary leakage: Double-J application
and donor age
• In the double-J group, 2 patients had urinary
leakage. One of the leakages was seen
postoperative 15th day, probably due to severe
acute rejection episode. Both leakages were
treated with suturing the hole.

Mean donor age was found to be 45.2 in the
patients whom urinary leakage was not
seen, while 52.1 in the patients with urinary
leakage.

9. Factors analyzed
p
Acute rejection
0.674
Acute tubular necrosis
0.203
Recipients gender
0.143
Delayed graft function
0.459
Usage of ATG
0.616
Donor gender
0.354
Multiple arteries
0.054
Warm ischemia time
0.199
Cold ischemia time
0.481

10. Factors analyzed
p
Double-J stent application
0.016
Donor type
0.176
Laparocopic donor nephrectomy
0.500
Donor age
0.025
Recipients age
0.270
Vascular complication
0.631

11. Discussion
The incidence of urinary leakage was 7.2% in our
series. The are many causes of urinary
leakage, but vascular insufficiency is probably
the most fundamental cause of ureteric necrosis
or slough with subsequent urinary extravasation.
We tried to avoid dissection of the renal hilum
during harvesting to preserve the vascular
supply of the ureter and to obtain sufficient
ureteric length to avoid unnecessary tension.

12. In one of the studies it was shown that at 3
months there were significantly more cases of
urinary leakage (8.9% vs 0.9%, p <0.008) and
ureteral obstruction (7.7 % vs 0%, p <0.004) in
the no-stent than in the stent group.
In another series it was shown that surgical
complication rates in renal transplantation
recipients according to donor type (living versus
cadaveric) and the status of stent use (with
stent versus without stent) were 5.53% vs.
7.27% (p = 0.064) and 5.24% vs. 20% (p<
0.01) respectively.

13. Many centers prefer using double-J stents to
reduce
ureteric
complications.
But, complications due to application double-J
stent itself can be seen. The most frequent
complication is infection. Longer period of
urethral catheterization may cause greater harm
to the normal urethral flora and may lead to a
higher incidence of urinary infection. When the
urethral catheters are removed within 1-4 days
of the renal transplant, the development of
urinary infection is unusual. there is a
significant
increase
in
urinary
tract
infections, primarily beyond 30 days after
transplantation. Stent removal within 4 weeks
of insertion appears advisable.

14. Conclusion
Although donor age was found to be one of
the two factors effecting urinary leakage;
insertion of double-J catheter was the only
one, which the surgeon could be able to
affect the course of the procedure. So, we
suggest the insertion of double-J catheter
in all renal transplantation procedures.