URORADIOLOGY
CASE PROFILE:
DONOR
GRAFT LITHIASIS
COMPLICATION
tributions,
NOTE
Tessler,
OF RENAL
FIGURE 1.
UROLOGY
UNUSUAL TRANSPLANTATION
Urograms of interest to our readers are welcome from urologists and radiologists. Conincluding an abbreviated history and legend for the jlms, are to be sent to Arthur N. M.D., feature editor.
A thirty-four-year-old female underwent renal transplantation for chronic pyelonephritis associated with bilateral vesicoureteral reflux. The cadaver graft was classically implanted retroperitoneally and the ureteroneocystotomy followed by excision of the residual ureteral stump. Excretory urography was performed because of impaired renal function and revealed a ureterohydronephrosis secondary to distal calculus ureteral stenosis and an unsuspected in an inferior calyx of the donor kidney (Fig. 1). On the thirtieth post-transplant day, the stenosed ureter was reimplanted and a pyelolithotomy perfbrmed. Following this procedure, renal function improved as did the pyelogram
nephrotic
-
Calculus in inferior transplant kidney.
/ DECEMBER1979
calyx
of hydro-
/ VOLUMEXIV,
NUMBER6
(Fig. 2). Her further transplant course was complicated by the development of a bleeding, erosive gastritis, responding to cimetidine treatment, and of a perforated sigmoidal lymphoma requiring a loop colostomy and allograft nephrectomy during the thirteenth posttransplant month. This resulted in a complete regression of the lymphoma. The patient is presently on a chronic dialysis program. Comment Lithiasis of the donor kidney been reported in the literature’ caused by (1) hyperparathyroidism
FIGURE 2. Following reimplantation hydronephrosis improved and calyces normal on intravenous pyelogram.
has seldom but can be (1 patient of
of ureter, appear
more
627
a series of 248 renal transplants*); (2) obstruction of the ureter, frequently at the anastomotic site (2 patients in our series who had had ureteral anastomosis*); (3) metabolic disease; (4) nonreabsorbable suture material; and (5) last but not least, the kidney graft itself. From the literature, we were unable to find “donor graft lithiasis” as a technical complication of renal transplantation. Routine abdominal and/or plain x-ray films in addition to inspection and palpation of the graft can be helpful to avoid the described “complication.” Care must be taken in all donor nephrectomies not only to preserve the renal and ureteral vessels but also to inspect the renal pelvis to exclude the presence of a graft calculus. This case is presented to stress the importance of donor nephrectomy in the tmns-
628
plantation procedure. This procedure should be performed by an experienced transplant team, and routine graft x-ray films can be helpful in recognizing donor graft lithiasis. J. Lerut,
M.D. (Reprints) T. Lerut, M.D. J. A. Gruwez, M.D. P. Michielsen, M.D. Transplant Unit Academic Hospital Sint-Raftil Leuven, Belgium Refermccs 1. Rosenberg JC, et al: Calculi complicating Am. J. Surg. 129: 326 (1975). 2. Lerut J. et al: Urological compliratims plants, in prms.
UROLOGY
/
DECEMBER
1979
/
VOLUME
a renal
transplant.
in 248 renal
XIV.
trans-
NUMBER
6
CASE PROFILE:
DONOR
GRAFT LITHIASIS
COMPLICATION
tributions,
NOTE
Tessler,
OF RENAL
FIGURE 1.
UROLOGY
UNUSUAL TRANSPLANTATION
Urograms of interest to our readers are welcome from urologists and radiologists. Conincluding an abbreviated history and legend for the jlms, are to be sent to Arthur N. M.D., feature editor.
A thirty-four-year-old female underwent renal transplantation for chronic pyelonephritis associated with bilateral vesicoureteral reflux. The cadaver graft was classically implanted retroperitoneally and the ureteroneocystotomy followed by excision of the residual ureteral stump. Excretory urography was performed because of impaired renal function and revealed a ureterohydronephrosis secondary to distal calculus ureteral stenosis and an unsuspected in an inferior calyx of the donor kidney (Fig. 1). On the thirtieth post-transplant day, the stenosed ureter was reimplanted and a pyelolithotomy perfbrmed. Following this procedure, renal function improved as did the pyelogram
nephrotic
-
Calculus in inferior transplant kidney.
/ DECEMBER1979
calyx
of hydro-
/ VOLUMEXIV,
NUMBER6
(Fig. 2). Her further transplant course was complicated by the development of a bleeding, erosive gastritis, responding to cimetidine treatment, and of a perforated sigmoidal lymphoma requiring a loop colostomy and allograft nephrectomy during the thirteenth posttransplant month. This resulted in a complete regression of the lymphoma. The patient is presently on a chronic dialysis program. Comment Lithiasis of the donor kidney been reported in the literature’ caused by (1) hyperparathyroidism
FIGURE 2. Following reimplantation hydronephrosis improved and calyces normal on intravenous pyelogram.
has seldom but can be (1 patient of
of ureter, appear
more
627
a series of 248 renal transplants*); (2) obstruction of the ureter, frequently at the anastomotic site (2 patients in our series who had had ureteral anastomosis*); (3) metabolic disease; (4) nonreabsorbable suture material; and (5) last but not least, the kidney graft itself. From the literature, we were unable to find “donor graft lithiasis” as a technical complication of renal transplantation. Routine abdominal and/or plain x-ray films in addition to inspection and palpation of the graft can be helpful to avoid the described “complication.” Care must be taken in all donor nephrectomies not only to preserve the renal and ureteral vessels but also to inspect the renal pelvis to exclude the presence of a graft calculus. This case is presented to stress the importance of donor nephrectomy in the tmns-
628
plantation procedure. This procedure should be performed by an experienced transplant team, and routine graft x-ray films can be helpful in recognizing donor graft lithiasis. J. Lerut,
M.D. (Reprints) T. Lerut, M.D. J. A. Gruwez, M.D. P. Michielsen, M.D. Transplant Unit Academic Hospital Sint-Raftil Leuven, Belgium Refermccs 1. Rosenberg JC, et al: Calculi complicating Am. J. Surg. 129: 326 (1975). 2. Lerut J. et al: Urological compliratims plants, in prms.
UROLOGY
/
DECEMBER
1979
/
VOLUME
a renal
transplant.
in 248 renal
XIV.
trans-
NUMBER
6
