Surgical complications in kidney transplantation. Analysis of our series (300 transplantations, 1986-1995)

Rioja Sanz, L. A.; Liédana Torres, J. M.; Roncalés Badal, A.; Rioja Sanz, C.; Rodríguez Vela, L.; Gill Martínez, P.; Gutiérrez Colón, J. A.

To review our series of 300 renal transplants, with special reference to the surgical complications and their management. From June, 1986 to August, 1995, we performed 300 heterotopic renal transplants harvested from cadavers. Reconstruction of the urinary tract was by ureteroneocystostomy in practically all of the cases. The overall surgical complication rate was 20.3%. The graft was lost in 2 cases (0.66%). The most common urological complication was obstruction of the urinary tract arising from stenosis (3.6%), lymphocele (5.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourological techniques. Urinary fistula was observed in 9 cases (3%) and lymphocele in 16 (5.3%), which were resolved by percutaneous drainage and sclerotherapy in 81.2% of the cases. Vascular complications were observed in 14 cases (4.6%), lithiasis in 5 (1.66%) and eventration in 6 (2%). The treatment of these complications are described. The actuarial graft and patient survival rates were 90.9% and 84.7% at one and five years, respectively, for the graft and 93.5% and 89% for the patients. Our surgical complication rate in patients undergoing renal transplantation was 20.3%. The most common complication was urinary tract obstruction from stenosis (3.6%), lymphocele (5.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourological techniques. Percutaneous drainage of the lymphocele combined with sclerotherapy achieved resolution in 81.2%. Renal biopsy performed with a 14 G needle caused 5 severe hemorrhagic complications. There were no complications when an 18 G needle was utilized.