Early Surgical Complications after Single Kidney Transplantation from Heart-Beating Deceased Donor

Abstract

To evaluate early surgical complications occurring in the first year after kidney transplantation, and their correlation with one-year patient and graft survival, we retrospectively evaluated 504 single kidney transplantations from heart-beating deceased donors performed in our center from 1993 to 2008. Twenty-seven re-transplanted patients, 10 living related, 8 double kidney, 9 combined liver-kidney, 3 heart-kidney, one heart-kidney-pancreas, and 12 kidney-pancreas transplantations were excluded from our study. Cases of immunological complications, systemic infections or primary disease recurrence were also excluded. There were 25 (4.96%) vascular complications: 3 cases of arterial thrombosis (0.6%), 11 of venous thrombosis (2.18%), and 2 cases of concomitant arterial and venous thrombosis (0.4%). There were 6 cases (1.2%) of arterial rupture due to pseudo-aneurysm; in 3 patients (0.6%) Candida Albicans was diagnosed as principal cause of arthritis. Fortythree (8.5%) patients developed early urinary complications, differentiated in leakage or stenosis. Intestinal complications occurred in 13 cases (2.6%), and 3 patients (0.6%) developed acute pancreatitis. In our series, complicated lymphoceles treated by open or laparoscopic surgery, or by the positioning of a Tenchkoff catheter occurred in 61 patients (12.10%). Median time between diagnosis and treatment was four days (range 1–12 days). Despite early surgical complications, one year patient and graft survival was 95.7% and 85.3%, respectively, similar to patients without complications (96.8% and 87.9%, respectively) (P=0.04). Kidney transplantation is currently considered a safe therapeutic option for endstage renal disease, with low morbidity, and very low mortality. Prompt diagnosis and immediate treatment of early surgical complications can have a positive impact on one-year patient and graft survival.