UROLOGICAL COMPLICATIONS IN RENAL-TRANSPLANTATION - A COMPARISON BETWEEN LIVING-RELATED AND CADAVERIC GRAFTS

Objective: Since 1989 the percentage of living-related donor renal tra nsplantations has increased considerably at our institution. We compar ed the incidence of urological complications in the living-related don or transplantation (LRDT) group and the cadaveric donor transplantatio n (CDT) group. Methods: Between September 1989 and September 1994, 534 consecutive patients underwent a renal transplantation. During that p eriod, the percentage of LRDT increased from 10 to 25 (mean: 14.8) per year. In all patients a transvesical ureteroneocystostomy without ant ireflux mechanism was performed. Results: A urological complication de veloped in 64 (11.9%) of the recipients (obstruction in 6.3%; leakage in 5.6%). In 41 (7.7%) patients the complication was transitory and co uld be managed with minimal invasive measures such as a percutaneous n ephrostomy (n = 34), drainage of a paraurethral fluid collection (n = 13), transurethral bladder drainage (n = 3) or a combination of these. In 23 (4.3%) of the recipients a secondary urological intervention su ch as a pyeloureterostomy (n = 21) or percutaneous dilatation of a ure teral stricture was necessary. The incidence of obstruction was equal in the LRDT and CDT groups, whereas leakage was more frequently encoun tered in the LRDT group (11.4 vs. 4.6%, p < 0.05). Transplant survival after 1 year was significantly better in the LRDT group than in the C DT group (97 vs. 77%, p < 0.001). Conclusion: The risk of leakage is h igher in living-related donor kidney transplantations. Urological comp lications, however, do not impair graft survival.