Risk Factors for the Occurrence of Early Postoperative Urological and Surgical Complications after Kidney Transplantation from a Living and Cadaveric Donor

Abstract

This study is based on a retrospective analysis of the medical history of 35 patients who underwent kidney transplantation at the Clinic of Urology of the “Alexandrovska” University Hospital, Sofia for the period from February 2018 to December 2019. Early postoperative complications were detected in 46% of the observed transplant patients. All possible early surgical and urological complications were followed up, including symptomatic and asymptomatic manifestations that did not require active invasive treatment. In our group of patients, possible factors, influencing the occurrence of early complications such as age and BMI of the recipient, age of the donor, preoperative hemodialysis and preoperative recipient residual diuresis, time of cold ischemia, creatinine levels at admission and discharge, hospital stay were studied. Our results show that the incidence of early postoperative urological and surgical complications correspond to the literature data from other transplant centres. We believe that higher preoperative residual diuresis is a good prognostic factor for lower rate of early postoperative complications. Prolonged time of cold ischemia does not affect the frequency of postoperative complications and allows better organization of operative activity. Obesity of the recipient is a risk factor for the occurrence of postoperative complications in transplant patients. In the studied group there is only a hint of the influence of the age of the recipient on the occurrence of complications without it reaching significant values. In our study, there was no relationship between the age of the donor and the occurrence of complications. Our opinion is that the age of the recipient and the donor does not in itself play a significant role, and it is much more important to increase the cardiovascular risk with age and against the background of emerging comorbidities. Serum creatinine levels at admission do not significantly affect the occurrence of early postoperative complications, but only suggest that quality of dialysis treatment plays an important role in the success of kidney transplantation. According to the values of serum creatinine at discharge, postoperative complications have a negative impact on the function of the transplanted kidney and their timely and adequate treatment is necessary to prolong the survival of the graft. The average length of hospital stay in the Clinic of Urology of “Alexandrovska” University Hospital for transplanted patients may be extended due to the specifics of the structure and organization of healthcare in the country.