Urological complications after renal transplantation using ureteroureteralanastomosis in children

Purpose: Ureterovesical reimplantation is most often performed for renal tr ansplantation in children. We reviewed our experience to evaluate the safet y and efficacy of ureteroureteral reimplantation in pediatric renal transpl antation. Materials and Methods: We retrospectively evaluated the charts of 92 boys a nd 72 girls who underwent a total of 166 ureteroureteral anastomoses for re nal transplantation from January 1990 to December 1999. Spatulated end-to-e nd anastomosis was performed between recipient and graft ureters without st enting and with a bladder catheter for at least 10 days. Results: Mean patient age at transplantation was 11.2 years (range 1 to 21. 5). There were 22 living related donor and 144 cadaveric grafts. Urological anomalies and nephropathy were the cause of end stage renal disease in 146 and 20 patients, respectively. Urological complications were noted in 14 o f the 166 transplantations (8.4%) in 10 boys and 4 girls, including 12 init ial and 2 repeat grafts from 2 living related and 12 cadaveric donors. Five of these patients had undergone previous urological surgery. The 2 childre n (1.2%) with acute ureteral obstruction underwent repeat intervention afte r stent failure. Anastomotic leakage in 7 cases (4.2%) was treated conserva tively in 1 and with a Double-J stent (Medical Engineering Corp., New York, New York) only required in 3. Reoperation was required in 3 cases. One pat ient (0.6%) with late ureteral stenosis underwent repeat anastomosis, 1 (0. 6%) required reimplantation for recurrent pyelonephritis due to vesicourete ral reflux in the graft, 1 (0.6%) with a valve bladder required bladder aug mentation and ureteral reimplantation, and 1 (0.6%) with lymphocele and 1 ( 0.6%) with lithiasis were successfully treated conservatively. Complication s were associated with acute rejection in 6 cases. Mean followup without gr aft loss in patients who presented with versus without complications was 58 .3 months (range 1 to 112) versus 75 (range 1 to 118). In the former patien ts with a mean age of 16 years 9 months versus those without urological com plications mean serum creatinine was 116 and 108 mol./l., respectively. Two grafts were lost in patients with urological complications, including 1 wh o died of pulmonary embolism and 1 with refractory chronic rejection. Seven patients were lost to followup after 54 months (range 12 to 113) of adequa te graft function. Conclusions: Ureteroureteral anastomosis is a safe and effective technique for pediatric renal transplantation with a low complication rate, which may be due to better vascularization of the shorter ureteral end of the graft. Our results should encourage the use of this technique in pediatric renal transplantation. Efforts to preserve the recipient ureters should be made a t nephrectomy.