Full-thickness Ureteroneocystostomy in Kidney Transplant: Evaluation of Complications and Graft Survival Outcomes at a High-volume Center

Abstract

Objectives: To report a large series where the full-thickness (FT) technique was applied and evaluate infectious and functional outcomes and compare these to the available literature. The ureteroneocystostomy technique of kidney transplantation has great variability. Kidney transplants performed at our institution use the FT technique as opposed to most centers. Ureteroneocystostomy performed without an anti-reflux mechanism (without tunneling) may increase the risk of acute renal graft pyelonephritis (AGPN) and thus compromise graft survival. Methods: Retrospective cohort study, based on 1275 medical records of kidney transplanted patients between 2007 and 2018. The outcomes were renal graft survival, ureteral complications, and occurrence of AGPN. Kaplan-Meier’s analysis is used to describe estimated time averages and variability through the Log-Rank test. Poisson regression model is used to estimate multivariable prevalence ratios. Results: We found that renal graft survival rates were comparable to those found in the literature. The AGPN rate in our series was 12.53 episodes/100 patient-years, like other series in the literature. The ureteral complications rates are also similar. Our limitations were the impossibility to compare our results with a controlled group and the limited data underlying pathologies, rejection, and type of immunosuppression. Conclusions: The FT technique has survival outcomes and complications comparable to those of the Lich-Gregoir (LG) technique. The FT technique is simple and quicker to perform than LG and is a suitable alternative for ureteroneocystostomy for kidney transplant procedure.