Long-term graft survival after urological complications of 695 kidney transplantations

Purpose: We ascertain the incidence, management and long-term outcome of ea rly urological complications requiring surgical exploration in kidney trans plantation. Materials and Methods: Data of 695 consecutive kidney transplantations perf ormed between January 1985 and January 1997 were assessed in regard to urol ogical complications that occurred within 1 year after transplant. A comput erized database was used to analyze graft recipient characteristics, the im plantation procedure, complications and outcome in select patients and all those who underwent transplant during the same period. In the noncomplicati on group sufficient data for evaluation was available for 556 patients. We performed the Cox proportional hazards analysis with overall graft failure, graft failure or death as end points of observation. Results: Overall, 42 (6.0%) patients required revision of vesicoureteral an astomosis. Complications were identified after a median of 6 days (range 0 to 135). The primary reconstruction technique was extravesical in 64% and t ransvesical in 33% of patients, including 1 that involved ureteral Bricker anastomosis. Obstruction and/or leakage at vesicoureteral anastomosis accou nted for 69% of urological complications. Revision was performed with a num ber of different reconstruction techniques. A second revision was required in 16.7%. Mean followup after primary transplant was 9.1 years (range 3.2 t o 15). Multivariate analysis showed that surgical treatment of urological c omplication during year 1 after kidney transplantation did not increase the risk of overall graft failure, graft failure or death. Conclusions: Our results indicate that long-term graft survival is not affe cted by a surgically treated urological complication.