Risk Factors for Transplant-Related Urinary Complications Characterized

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MIAMI BEACH, Fla.—A review of 635 kidney transplants performed at the University of Florida, Gainesville, has confirmed that transplanted kidneys with more than one renal artery put recipients at increased risk for urinary complications.

The researchers found that renal-artery multiplicity in transplanted kidneys is associated with a statistically significant 2.5-fold higher risk of urinary complications compared with organs that have only one renal artery, according to a poster presentation at the American Society of Transplant Surgeon's 2012 Annual State of the Art Winter Symposium.

Rupak Kulkarni, MD, and three other transplant surgeons analyzed the urinary complication outcomes of transplants performed between December 1, 2006 and December 31, 2010. All patients had at least six months of follow-up data available.

They evaluated 34 characteristics of the donors and recipients. These included some parameters that have been evaluated in previous research–including donor and recipient age, donor and recipient race, and cold ischemia time of more than 24 hours. They also analyzed some that had not been previously examined, including whether the kidneys had been imported from outside of the local catchment area.

Urinary complications developed in 19 (4.6%) of the 635 transplants. These included 17 strictures (58.6%), seven leaks (24.1%), and five (17.2%) stones or internal hematomas.

Univariate analysis revealed only two factors associated with a statistically significant increased risk of urinary complications: double-kidney transplantation, which was associated with a 2.72 times increased risk, and the presence of more than one renal artery, which was associated with a 2.48-fold increased risk. On multivariate analysis, however, only renal-artery multiplicity remained statistically significant, with a 2.5-fold increased risk.

The researchers observed trends toward urinary complications with donor age of 60 years or older, re-transplants, and ligation of the lower pole artery, but these trends did not reach statistical significance possibly because of the small sample size of subgroups with these complications.

“The results confirm that our judgment regarding kidney choice—such as preservation of the inferior pole renal artery if previously transected—is resulting in excellent outcomes,” Dr. Kulkarni said.

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