Ea. Kouwenhoven et al., Ureteroneocystostomy contributes to late functional and morphological changes in rat kidney transplants, J UROL, 165(5), 2001, pp. 1700-1704
Purpose: We investigated whether the surgical technique used to reconstruct
the ureter has an impact on the late function of kidney transplants by com
paring ureteroneocystostomy and ureteroureterostomy. To rule out alloantige
neic mediated effects on late graft dysfunction kidney transplants were per
formed in a syngeneic model.
Materials and Methods: Rat kidney isografts were transplanted with simultan
eous ureteroneocystostomy or ureteroureterostomy. Unilaterally nephrectomiz
ed rats sen ed as controls. Eight weeks after transplantation intrapelvic p
ressure was measured during baseline diuresis, and after intravesical and i
ntrapelvic infusion. Albuminuria was determined monthly until sacrifice at
week 52. Histomorphological analysis included the degree of glomerulopathy,
tubular atrophy, interstitial fibrosis and intimal hyperplasia, CD4(+)- an
d CD8(+) T cells, and macrophages were identified using immunohistochemical
testing.
Results: Eight weeks after transplantation intrapelvic pressure during base
line diuresis and after intrapelvic infusion was significantly increased in
rats with ureteroneocystostomy versus those with ureterostomy and unilater
al nephrectomy, whereas intravesical infusion did not change the pressure i
n any group. During followup albuminuria after ureteroureterostomy did not
differ from that after unilateral nephrectomy. In contrast, albuminuria sig
nificantly increased after ureteroneocystostomy from week 36 onward. At wee
k 52 the uteter and kidney after ureteroureterostomy and unilateral nephrec
tomy had a normal appearance, whereas all ureters were dilated after ureter
oneocystostomy. Nevertheless, 6 of the 3 kidneys in the ureteroneocystostom
y group had a normal appearance. However, histomorphological findings in ra
ts with transplants and ureterovesical anastomosis demonstrated significant
ly more interstitial fibrosis, CD8(+) T cells and macrophages than isograft
s ureteroureterostomy.
Conclusions: As a surgical technique for restoring the urinary tract after
kidney transplantation, ureteroneocystostomy contributes to the development
, of long-term functional and histological renal changes. Partial obstructi
on mag be the cause of this renal impairment.