Complications following transplantation

Despite the remarkable development of kidney transplantation techniques, su rgical complications are still a very important factor affecting the final outcome of kidney transplantation. After 92 kidney transplantations (22 fro m cadaver donors and 70 from living donors) performed at Skopje hospital (M acedonia), we observed the following complications: nine (10%) urinary fist ula, five (5%) graft ruptures, seven (8%) lymphoceles, two (2%) urinary cal culosis, two (2%) intestinal perforations, four (4%) renal artery stenoses, one (1%) renal artery thrombosis, and seven (8%) early complications follo wing surgical incision. Complications were detected by either ultrasonograp hy, intravenous pyelography, percutaneous nephrostomy with anterograde pyel ography, computerized tomography, and intravenous digital angiography. They were subsequently treated by application of modern surgical procedures : u se of the ureter (termino-terminal or uretero-pyelic anastomosis) for treat ment of urinary fistulas; conservative surgery using tissue glue and extern al compression with polyglactin 910 (Vicryl(R)) mesh for graft ruptures; dr ainage and application of sclerosants under ultrasound control and intraper itoneal marsupialization for the clinically relevant lymphoceles; translumi nal angioplasty with balloon dilatation in case of significant arterial ste nosis; extracorporeal shock wave lithotripsy and surgery for urinary calcul i. Intestinal perforations and problems relating to parietal tissue were qu ickly solved using standard surgical techniques. On total, rejection of the graft occurred in four (4%) cases following surgical complications, while one death was encountered due to septic peritonitis. We consider the percen tage of surgical complications acceptable, as this work consists of a pione ering effort in this Balkan region. (C) 2000 Editions scientifiques et medi cales Elsevier SAS.