Michele Morelli1,2,3,4, Romain Boissier1,3, Abel Tadrist1,3, Bastien Gondran-Tellier1,3, Robin McManus1, Akram Akiki1,3, Véronique Delaporte1,3, Gilles Karsenty1,3, Sergio Concetti5, Emanuele Montanari2,4, Eric Lechevallier1,3, Michael Baboudjian6,7. 1. Department of Urology and Kidney Transplantation, Conception Academic Hospital, AP-HM, 147 Bd Baille, 13005, Marseilles, France. 2. University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy. 3. Aix-Marseille University, 58 Bd Charles Livon, 13007, Marseilles, France. 4. Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 5. Urology Unit, Surgical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy. 6. Department of Urology and Kidney Transplantation, Conception Academic Hospital, AP-HM, 147 Bd Baille, 13005, Marseilles, France. Michael.BABOUDJIAN@ap-hm.fr. 7. Aix-Marseille University, 58 Bd Charles Livon, 13007, Marseilles, France. Michael.BABOUDJIAN@ap-hm.fr.
Abstract
PURPOSE: To evaluate the outcomes of ureteral reimplantation (UR) after failure of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) in renal transplant recipients. METHODS: We conducted a monocentric retrospective study that included all renal transplant recipients with failure of Deflux™ as first-line treatment of VUR from January 2007 to December 2020. Failure of Deflux™ was defined by: VUR on retrograde cystography and at least one acute pyelonephritis of the renal graft. The preferred surgical treatment was native ureteropyelostomy (NPUS) in the recent years. If the native ureter could not be used, ureteroneocystostomy (UNC) was performed. The primary outcome was the clinical efficacy of UR defined as the absence of acute graft pyelonephritis during follow-up. RESULTS: Out of 1565 kidney transplantations, 119 (7.6%) had symptomatic VUR treated with bulking agent. 35 (29.4%) had Deflux™ failure and were addressed to UR: 21/35 (60%) NPUS and 14/35 (40%) UNC. The median estimated blood loss, operative time, and length of stay were 120 mL, 90 min, and 7 days, respectively. After a median follow-up of 7.1 (IQR 4.1-9.8) years, UR was clinically successful in a total of 32 patients (91.4%): 20 (95.2%) and 12 (85.7%) patients in the NPUS and UNC groups, respectively (p = 0.55). Three (8.5%) high-grade complications have been reported. No nephrectomy of native kidney was required in the NPUS group. CONCLUSIONS: After failure of Deflux™ for VUR of renal graft, surgical treatment with native ureteropyelostomy or ureteroneocystostomy is associated to a high success rate and few high-grade complications.
PURPOSE: To evaluate the outcomes of ureteral reimplantation (UR) after failure of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) in renal transplant recipients. METHODS: We conducted a monocentric retrospective study that included all renal transplant recipients with failure of Deflux™ as first-line treatment of VUR from January 2007 to December 2020. Failure of Deflux™ was defined by: VUR on retrograde cystography and at least one acute pyelonephritis of the renal graft. The preferred surgical treatment was native ureteropyelostomy (NPUS) in the recent years. If the native ureter could not be used, ureteroneocystostomy (UNC) was performed. The primary outcome was the clinical efficacy of UR defined as the absence of acute graft pyelonephritis during follow-up. RESULTS: Out of 1565 kidney transplantations, 119 (7.6%) had symptomatic VUR treated with bulking agent. 35 (29.4%) had Deflux™ failure and were addressed to UR: 21/35 (60%) NPUS and 14/35 (40%) UNC. The median estimated blood loss, operative time, and length of stay were 120 mL, 90 min, and 7 days, respectively. After a median follow-up of 7.1 (IQR 4.1-9.8) years, UR was clinically successful in a total of 32 patients (91.4%): 20 (95.2%) and 12 (85.7%) patients in the NPUS and UNC groups, respectively (p = 0.55). Three (8.5%) high-grade complications have been reported. No nephrectomy of native kidney was required in the NPUS group. CONCLUSIONS: After failure of Deflux™ for VUR of renal graft, surgical treatment with native ureteropyelostomy or ureteroneocystostomy is associated to a high success rate and few high-grade complications.
Authors: A Faenza; B Nardo; F Catena; M P Scolari; G L d'Arcangelo; A Buscaroli; C Rossi; M Zompatori Journal: Transpl Int Date: 1999 Impact factor: 3.782
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