Ureteral stenosis after kidney transplantation - A study on 869 consecutive transplants

Ureteral obstruction with impaired urine flow is the most common urological complication following renal transplantation. From December 1976 to Decemb er 1997, 869 kidney grafts were performed by our kidney transplantation gro up, 96 from living related donors and 773 from cadaver donors (736 first gr afts and 37 regrafts). A stricture of the ureter (SU) was observed in 27 ca ses with a follow-up ranging from 18 months to 18 years after the graft and 11 months to 11 years after the treatment of the SU. In six patients, SU w as immediately apparent and limited to the anastomosis: they were obviously technical flaws. In all the other patients, there was a free interval rang ing from 2 months to 11 years after surgery; the SU usually involved the en tire ureter, suggesting multiple etiologies. Repeated urinary infections co uld be a cause but immunological problems might be more determinant. In our series, acute rejection was more common than chronic so that the correctio n of SU was followed in many cases by a good and long lasting result (up to 11 years). In our experience, SU was not a dangerous complication even in patients in whom for different reasons (mainly refusal of treatment) the th erapy was delayed even if anuria occurred, no case of graft loss or serious damage were observed. At the beginning of our experience, the diagnosis of SU was based on urography, and therapy has always been re-operation. For 1 5 years, the diagnosis of SU has been based on routine echographic surveill ance, which was intensified after each rejection, and the first treatment o f SU in the last 8 years was re-operation in early technical SU and interve ntional radiology (balloon dilatation with or without temporary stent) in o ther cases. When it failed or in case of recurrence, surgical correction wa s performed utilizing the native ipsilateral or contralateral ureter for a ureteroureterostomy.