Ureteral complications in renal transplantation with more than one donor ureter

Background. The purpose of this study was to evaluate the ureteral complica tions of renal transplant recipients with more than one donor ureter Methods. Between 1967 and 1997, 19 patients (median age 34 years, range 6-6 2 years) received renal transplants from donors with more than one ureter. There were 18 donor organs with two ureters, and one patient underwent en b loc renal transplantation with four donor ureters. In nine patients, the ur eters were implanted separately at the bladder dome according to the extrav esical technique of Witzel, Sampson, Lich and Rohl. In 10 patients, we perf ormed a modification of this extravesical technique according to Nghiem wit h a side-to-side anastomosis of the ureters before completing the ureterone ocystostomy. Results. After a median follow-up of 55 months (range 2-218 months), no gra ft loss due to ureteral complications was noted. One patient died due to my ocardial infarction, seven patients returned to dialysis without ureteral c omplications. There were two patients (one patient after side-to-side urete ral anastomosis, one patient with separate implantation of the two ureters) with ureteral obstruction of one donor ureter. Both patients underwent ope n surgical revision with temporarily placement of internal ureteral stents. Conclusions. The presence of multiple ureters from donor kidneys is associa ted with a higher complication rate in our patient population compared with donor kidneys with one ureter. There was no difference in the long-term ou tcome between the two implantation techniques used.