KIDNEY TRANSPLANTATION – EARLY POSTOPERATIVE COMPLICATIONS
Jun 25, 2023
ABSTRACT
1. Introduction
Kidney transplantation is an established surgical method for the treatment of end-stage chronic renal failure with good long-term results. Despite the continuous progress and development of transplantology, several postoperative surgical and urological complications still occur today, which could compromise the success of this operative method.
2. Purpose
All possible surgical and urological complications in the first 60 days after kidney transplantation were followed up.
Materials and Methods
This study is based on a retrospective analysis of the disease history of 35 patients who underwent kidney transplantation at the Clinic of Urology at the UMHAT “Alexandrovska” for the period from 02.2018 to 12.2019. Results: Early postoperative complications were found in 46% of the observed transplant patients. Urological complications were found in 26% of them.
3. Discussion
The incidence of urinary tract infections in transplanted patients was 26%. During the follow-up period, there were no cases of urinary retention, stricture of the ureter, or urinoma in the group of patients. The incidence of surgical complications in the transplanted patients was 29%. The incidence of postoperative hematomas was 23%. Postoperative lymphocele was diagnosed in one patient, which shows a complication rate of 3% for this diagnosis. The incidence of surgical wound infection in transplanted patients during the follow-up period was 3%.
4. Conclusions
Our results show that the frequency of the different early postoperative urological and surgical complications correspond to the literature data from other transplant centers. They show that the transplantation activities in the Clinic of Urology in UMHAT “Alexandrovska” correspond to the world standards.
5. Keywords
urological, surgical, complications, transplantation, donor
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INTRODUCTION
1. Brief historical data on kidney transplantation
In 1902, Austrian surgeon H. Ullman from Vienna performed the first kidney transplantation on a dog, which was assessed as technically successful. He implanted the kidney in the dog’s neck area, anastomosing the ureter on the skin so that he could monitor diuresis - the kidney excreted urine for five days. In 1906, the first attempts at kidney transplantation from animals to humans were made by Dr. Mathieu Jaboulay from Lyon, but these operations proved unsuccessful. In 1933, the first kidney transplantation was performed from a cadaver by Dr. Yu Yu Voronoy from Kyiv. The recipient lived for 4 days, and the transplanted kidney never worked. In 1952, the first kidney transplantation from a living donor (mother of a child) was performed by Prof. Hamburger in Paris. Unfortunately, it had a very short time of success. On December 23, 1954, Dr. Joseph Murray from Boston performed the first successful kidney transplantation. The transplantation was performed between identical twins - is transplantation. Oscar Creech and Keith Reemtsma transplanted a kidney and a heart from a chimpanzee to a human. The survival of several of the patients for months suggests that in the presence of quality immunosuppressive therapy, organ transplantation between different species (xenotransplantation) is possible. Thomas Starzl tried to transplant a kidney from a baboon to a patient in a very severe condition, but the operation was unsuccessful.
The first kidney transplantation in Bulgaria was performed in 1968 in Pirogov Hospital by Prof. Minkov et al. The recipient was a child whose solitary kidney was removed after an injury. The patient underwent transplantation of two kidneys placed in the pelvis. On February 1, 1969, Prof. N. Atanasov and Prof. St. Lambrev performed the first organ transplantation in Alexandrovska Hospital - a 42-year-old woman suffering from endemic nephropathy received a kidney transplant. The Clinic of Urology of UMHAT “Alexandrovska” over time has become a leading center in the country for kidney transplantation.
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2. Kidney transplantation today
Nowadays, kidney transplantation is an established surgical method for the treatment of end-stage of chronic renal failure with good long-term results. Compared to dialysis, kidney transplantation significantly improves the quality of life of the patients, and their physical endurance promotes social integration and reduces the incidence of chronic dialysis-related diseases. From an economic point of view, kidney transplantation leads to a significant reduction in treatment costs for patients with end-stage chronic renal failure. Successful kidney transplantation, including follow-up of the patient during the first year, costs as much as two years of dialysis. The average duration of transplanted kidney function after transplantation is 9 years. There are cases in which good graft function was observed after 20 years or more. Life expectancy in transplanted patients is significantly longer than in dialysis patients.
3. Postoperative complications of kidney transplantation
Despite the continuous progress and development of transplantology, several postoperative surgical and urological complications still occur today. Surgical postoperative complications include vascular problems such as venous and arterial thrombosis of the graft, renal artery stenosis, lymphocele, etc. Other complications are related to the surgical wound - infections, dehiscence, and hernias. Hemorrhagic complications include diffuse tissue bleeding and bleeding from vascular anastomoses. The most common complications are related to the operative wound (between 12- 36%), followed by hematomas (between 2 and 25%), and the least common are vascular complications (between 1 and 12%). Urological complications also affect the postoperative period in kidney transplantation. These include urine leakage from the vesico-ureteroneostomy, urinoma, ureteral obstruction, urinary tract infections, vesicoureteral reflux, and urolithiasis. Their frequency rate is between 2-37%.
The timely diagnosis and appropriate treatment of surgical and urological complications are of great importance. There are numerous, mostly retrospective studies in the literature on the frequency of surgical and urological complications after kidney transplantation and their relevant risk factors. Most articles focus on single surgical or urological complications. Studies that summarize all possible complications are extremely rare.
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PURPOSE AND TASKS
Our goals and tasks were to update our knowledge in translatology, to get acquainted with the current scientific literature data on this issue, and to summarize our data on early postoperative urological and surgical complications after kidney transplantation. We also set ourselves the goal to evaluate our results and compare them with the data available in the contemporary medical literature on this topic.
MATERIAL AND METHODS
This study is based on a retrospective analysis of the disease history of 35 patients who underwent kidney transplantation in the Clinic of Urology, UMHAT “Alexandrovska” for the period from 02.2018 to 12.2019. The cohort of patients consists of 28 men and 7 women. The mean age of the patients was 43 years (median 42 years). The mean age of women and men was 41 and 44 years, respectively. One of the men received a kidney transplant for a second time. The study included patients transplanted from a living and cadaveric donor. In our study, the number of kidney transplants from a living donor was 3, and those from a cadaveric donor - were 22. The follow-up period for early postoperative complications was 60 days after surgery.
DISCUSSION
A significant decrease in the incidence of urological and surgical postoperative complications has been achieved over the years with the development of transplantology and different minimally invasive techniques. This is of great importance because the occurrence of such complications after kidney transplantation may lead to increased morbidity and mortality in transplanted patients.
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SUMMARY AND CONCLUSIONS
Early postoperative complications were observed in 46% of the transplanted patients. Urological complications developed in 26% of them. The incidence of urinary tract infections in transplanted patients was 26%. We do not observe any urinary retention, stricture of the ureter, or urinoma during the follow-up period.
The incidence of surgical complications in transplanted patients was 29%. One patient in our group developed postoperative lymphocele, which shows a complication rate of 3%. Surgical wound infection was found in 3%. No cases of venous or arterial thrombosis and hernia in the area of the operative wound were observed during the follow-up period.
1. Our results show that the frequency of individual early postoperative urological and surgical complications corresponds to the literature data from other transplant centers.
2. The average time of hospital stay in the Clinic of Urology, UMHAT “Alexandrovska” for transplanted patients could depend on some features of the healthcare system in the country.
3. Our results suggest that the Clinic of Urology, UMHAT “Alexandrovska” performs transplantation activities that are adequate to world standards in kidney transplantation.
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Vladislav Mladenov1, Ivan Lilianov1, Boris Botev1, Valeria Hadjiiska2, Andrian Tonev1
1) Clinic of Urology, UMHAT “Alexandrovska”, Medical University - Sofia, Bulgaria.
2) Clinic of Nuclear Medicine, UMHAT “Alexandrovska”, Medical University - Sofia, Bulgaria.
