Late Surgical Complications After Kidney Transplantation
Özet
Late-stage surgical complications affecting long-term graft survival after kidney transplantation typically present with atypical symptoms—such as an increase in creatinine, decreased urine output, or asymptomatic hydronephrosis—rather than classic pain or fever. This is due to the immunosuppressive drugs used by patients and the lack of a neural network (denervation) in the transplanted kidney. Ureteral strictures, which are among the leading complications and develop due to ischemic injury in most cases, are managed using ultrasonography for diagnosis and the insertion of a percutaneous nephrostomy to preserve kidney function. While endoscopic methods such as lasers or balloons are preferred for strictures shorter than three centimeters, surgical repair (reconstruction) utilizing the patient's own healthy ureter is mandatory for longer and resistant cases. Stone disease, another significant issue, has a bidirectional relationship with ureteral strictures and infections, and patients do not experience typical kidney stone pain. In the treatment of stones, those smaller than 4 mm are monitored, while depending on the size and location, extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) performed with flexible ureteroscopes, or percutaneous nephrolithotomy (PCNL) for stones larger than 2 cm are applied. In these patients, who have an increased risk of cancer due to the suppression of the immune system, macroscopic hematuria (visible blood in the urine) should always be considered a critical early symptom for urothelial carcinoma; cystoscopy and careful imaging that does not put kidney function at risk must be performed. Additionally, it is of vital importance to conduct annual ultrasound screenings on high-risk groups for renal cell carcinoma, which frequently emerges in the patients' own native kidneys rather than the transplanted kidney. Finally, in late-stage urinary leaks (fistulas), decompression is primarily attempted using conservative methods such as stents and nephrostomy; if there is no response, open surgery is initiated. Furthermore, because leaving ureteral stents—used during the healing process—forgotten in the body for extended periods can lead to encrustation (calcification) and resistant infections resulting in graft loss, it is imperative for hospitals to implement strict stent follow-up protocols.
Referanslar
Alwesali SM. A long forgotten ureteral stent for 13 years post renal transplantation. Urol Case Rep. 2022;44:102156.
Seito T, Kondo T, Takagi T, et al. Bladder preservation after bilateral kidney loss and bladder cancer after renal transplantation: A case report. Transplant Proc. 2023;55(3):660-663.
Lee HJ, Kim SH, Lee JY, et al. De novo urological malignancies after renal transplantation: An Asian 30-year experience. Clin Transplant. 2024;38(2):e15415.
Coleman JA, Clark PE, Bixler BR, et al. Diagnosis and management of non-metastatic upper tract urothelial carcinoma: AUA/SUO guideline. J Urol. 2023;209(6):1071-1081.
Yin S, Zhang X, Liu Y, et al. Do ureteral stents improve clinical outcomes in renal transplantation? A systematic review and meta-analysis comparing stented and non-stented anastomosis techniques. PeerJ. 2026;14:e20665.
Wang Y, Liu X, Chen J, et al. Dynamic viral integration patterns in BK polyomavirus-associated diseases after renal transplantation. Am J Transplant. 2023;23(10):1694-1708.
Kusuma MHH, Ghinorawa T, Hardjo IS, et al. Early ureteral stent removal reduces urinary tract infection risk without increasing complications in living donor kidney transplantation: A systematic review and meta-analysis. Clin Transplant. 2025;39(3):308-316.
Guvence N, Oskay K, Karabulut I, et al. Effects of ureteral stent on urologic complications in renal transplant recipients: A retrospective study. Ren Fail. 2009;31(10):899-903.
Faba OR, Breda A, Budde K, et al. European Association of Urology guidelines on renal transplantation: Update 2024. Eur Urol Focus. 2025;11(2):365-373.
Tillou X, Le Bloa L, Courteille V, et al. First full intracorporeal robotic cystectomy and neobladder in a renal transplant recipient. J Surg Case Rep. 2025;2025(1):rjaf009.
Bhuva S, Kennish SJ, Wah TM. Forgotten indwelling stent in a transplanted kidney: A case report. Cases J. 2009;2:27
Harza M, Baston C, Preda A, et al. Impact of ureteral stenting on urological complications after kidney transplantation surgery: A single-center experience. Transplant Proc. 2014;46(10):3459-3462.
Chewcharat A, Thongprayoon C, Bathini T, et al. Incidence and mortality of renal cell carcinoma after kidney transplantation: A meta-analysis. J Clin Med. 2019;8(4):530.
Cheungpasitporn W, Thongprayoon C, O’Corragain OA, et al. Incidence of kidney stones in kidney transplant recipients: A systematic review and meta-analysis. World J Transplant. 2016;6(4):790-797.
Li D, Zhang Y, Wang H, et al. Ipsilateral synchronous papillary renal neoplasm with reverse polarity and urothelial carcinoma in a renal transplant recipient: A rare case report. Diagn Pathol. 2023;18(1):120.
Piana A, Rizzo M, Amparore D, et al. Kidney stones in renal transplant recipients: A systematic review. Actas Urol Esp (Engl Ed). 2024;48(2):79-104.
Małyszko SJ, Małyszko J, Kozłowska K, et al. Malignancy of urinary tract in kidney transplant recipients: A narrative review. Cancers (Basel). 2026;18(3):695.
Patel S, Shah S, Patel N, et al. Risk factors and rates of ureteral stricture formation following renal transplantation: A literature review. Exp Clin Transplant. 2024;22(6):655-663.
Ito A, Ohyama T, Minamisono K, et al. Second renal transplantation with simultaneous ileal conduit creation following transplant nephroureterectomy and native cystectomy. IJU Case Rep. 2025;8(5):377-381.
Yamanaka K, Tanaka T, Fujimoto K, et al. Surgical and infectious complications following kidney transplantation: A contemporary review. J Clin Med. 2025;14(10):3307.
Fakhr Yasseri A, Roshani D, Kachooei AR, et al. Prevalence of renal stones and outcomes of conservative treatment in kidney transplantation: A systematic review and meta-analysis. Urol J. 2021;18(3):252-258.
Figaroa OJA, van der Heijden AG, Witjes JA, et al. Incidence of upper tract urothelial carcinoma following renal transplantation in the Netherlands. Eur Urol Open Sci. 2025;76:1-6.
Kumar S, Sharma A, Ganesamoni R, et al. Ureteral obstruction following renal transplantation: Causes, diagnosis and management. Br J Radiol. 2014;87(1039):20140169.
Novacescu D, Radu D, Mischie A, et al. Ureteric complications and urinary tract reconstruction techniques in renal transplantation: A surgical essay. J Clin Med. 2025;14(12):4129.
Mirza A, Khan S, Ahmed S, et al. Ureteric trauma following stent removal in kidney transplant recipient: A case report. Case Rep Transplant. 2021;2021:9959074.
