Experience with renal transplantation in the nonhuman primate: A modified ureteroneocystostomy to prevent urologic complications

Nonhuman primates provide an optimal model for the evaluation of tolerance in the preclinical setting. Transplantation and management of nonhuman prim ates are technically demanding, and the purpose of this article is to revie w our extensive experience in renal transplantation in non-human primates, with particular emphasis on modifications of surgical techniques on urologi c complications. We retrospectively reviewed our results with 329 renal tra nsplants in rhesus monkeys over an 18-year period. The surgical technique a nd, in particular, the ureteroneocystostomy have evolved over this period o f time. This review extensively details our current technique, the surgical and urologic complications,and their management. There were 329 renal tran splants performed. There were 85 early deaths, or animals euthanized, withi n 30 days of the transplant operation. In the first 15 years, there were 27 (10.68%) surgical complications that required euthanasia, and in the last 3 years the complication rate has been reduced to 5 (7.3%, p < .05). The ro utine use of microsurgical techniques has reduced the incidence of arterial thrombosis (6.2% vs. 2.9%, p < .05). The incidence of ureteral strictures (15 vs. 0, p < .005) has been reduced by a modification of the ureteroneocy stostomy technique detailed in the text. Renal transplantation in small rhe sus monkeys is technically demanding. The routine use of microsurgical tech niques and a modified ureteroneocystostomy has reduced the incidence of sur gical complications.