Laiko Hospital, 1st Dept of Urology, Athens Medical School, 13 Dios str, Athens, Greece, 14564.
Renal transplant lithiasis represents a rather uncommon complication. Even rare, it can result in significant morbidity and a devastating loss of renal function if obstruction occurs. We present our experience with graft lithiasis in our series of renal transplantations and review the literature regarding the epidemiology, pathophysiology and current therapeutic strategies in the management of renal transplant lithiasis.
In a retrospective analysis of a consecutive series of 1525 renal transplantations that were performed between January 1983 and March 2007, 7 patients were found to suffer from allograft lithiasis. In 5 cases the calculi were localized in the renal unit and in 2 cases in the ureter. A review in the English language was also performed of the Medline and Pub Med databases using the keywords "renal transplant lithiasis", "donor-gifted lithiasis", "urological complications after kidney transplantation". Several retrospective studies regarding the incidence, aetiology, as well as predisposing factors for graft lithiasis were reviewed. Data regarding the current therapeutic strategies for graft lithiasis was also evaluated and outcomes were compared to the results of our series.
Most studies report a renal transplant lithiasis incidence of 0.4 - 1%. In our series incidence of graft lithiasis was 0.46% (n=7). Of the 7 patients 3 were treated via Percutaneous Nephrolithotripsy (PNL), in 3 patients Shock Wave Lithotripsy (SWL) was carried out and in a single case a spontaneous passage of a urinary calculus was observed. All patients are currently stone free but still remain under close urologic surveillance.
Renal transplant lithiasis requires vigilance, a high index of suspicion, prompt recognition and management. Treatment protocols should mimic those for solitary kidneys. Minimal invasive techniques are nowadays available to remove graft calculi. A long term follow up is essential to determine the outcome, as well as to prevent recurrence.
Written by:
Stravodimos KG, Adamis S, Tyritzis S, Georgios Z, Constantinides CA. Are you the author?
Reference: J Endourol. 2011 Nov 3. Epub ahead of print.
doi: 10.1089/end.2011.0049
PubMed Abstract
PMID: 22050494
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