Research Article

Urine Leak Following Kidney Transplantation: An Evidence-based Management Plan

Shafiq A Chughtai, Ajay Sharma and Ahmed Halawa*

Published: 10/02/2018 | Volume 2 - Issue 3 | Pages: 044-052

Abstract

Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. Ongoing urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life and reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.

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References

  1. National Institute of Diabetes and Digestive and Kidney Diseases. Kidney Disease Statistics for the United States. 2018; Ref.: https://goo.gl/ZwXe22
  2. Lempinen J, Stenman J, Kyllonen L, Salmela K. Surgical Complications following 1670 consecutive adult renal transplantations: a single center study. Scand J Surg. 2015;104: 254-259. Ref.: https://goo.gl/9amz93
  3. Neri F, Tsivian M, Coccolini F, Bertelli R, Cavallari G, et al. Urological complications after Kidney transplantation: experience of more than 1000 transplantations. Transplant Proc 2009; 41:1224-1226. Ref.: https://goo.gl/8zmZti
  4. Streeter EH, Little DM, Cranston DW, Morris PJ. The urological complications of renal transplantation: a series of 1535 patients. BJU Int. 2002; 90: 627-634. Ref.: https://goo.gl/fSauZE
  5. Guerrero-Ramos F, Cavero-Escribano T, Rodríguez-Antolín A, Andrés-Belmonte A, Passas-Martínez J, et al. Perigraft fluid collections after kidney transplantation: Does the type of donor (uncontrolled donation after circulatory death vs. donation after brain death) have a role? Cent European J Urol. 2017; 70: 439–444. Ref.: https://goo.gl/fhP8Jd
  6. Hachem LD, Ghanekar A, Selzner M, Famure O, Li Y, et al J. Postoperative surgical-site haemorrhage after kidney transplantation: incidence, risk factors, and outcomes. Transpl Int. 2017; 30: 474-483. Ref.: https://goo.gl/RVNurw
  7. Chung J, Caumartin Y, Warren J, Luke PP. Acute Page kidney following renal allograft biopsy: a complication requiring early recognition and treatment. Am J Transplant. 2008; 8: 1323-1328. Ref.: https://goo.gl/beuYs9
  8. Humar A, Matas AJ. Surgical complications after kidney transplantation. Semin Dial. 2005;18: 505-510. Ref.: https://goo.gl/pxR9vd
  9. Fuller TF, Kang SM, Hirose R, Feng S, Stock PG. et al. Management of lymphocele after renal transplantation: laparoscopic vs open drainage. J Urol. 2003; 169: 2022-2025. Ref.: https://goo.gl/2yMCBp
  10. Langer RM, Kahan BD. Incidence, therapy and consequence s of lymphocele after sirolimus-cyclosporine-prednisone immunosuppression in renal transplant recipients. Transplantation 2002; 74: 804-808. Ref.: https://goo.gl/RYco3z
  11. Zukerman DA, Yeager TD. Percutaneous ethanol sclerotherapy of postoperative lymphocele. AJR Am J Roentgenol. 1997; 169: 433-437. Ref.: https://goo.gl/JKbQtJ
  12. Chandrasekaran D, Meyyappan RM, Rajaraman T. Instillation of povidone iodine to treat and prevent lymphocele after renal transplantation. BJU Int. 2003; 91: 296. Ref.: https://goo.gl/xjqeLJ
  13. Manfro RC, Comerlato L, Berdichevski RH, Ribeiro AR, Denicol NT, et al. Nephrotoxic acute renal failure in a renal transplant patient with recurrent lymphocele treated with povidone-iodine irrigation. Am J Kidney Dis. 2002; 40: 655-657. Ref.: https://goo.gl/rrZnBb
  14. Bzoma B, Kostro J, Dębska-Ślizień A, Hellmann AR, Zadrożny D, et al. Treatment of the Lymphocele After Kidney Transplantation: A Single-center Experience. Transplant Proc. 2016; 48: 1637-1640. Ref.: https://goo.gl/f9Z4iG
  15. Schachtner T, Stein M, Reinke P. Sepsis after renal transplantation: Clinical, immunological, and microbiological risk factors. Transpl Infect Dis 2017; 19. Ref.: https://goo.gl/yJfsVi
  16. Ministro A, Ferreira T, Batista L, Santana A, Alves N, et al. Mycotic Pseudoaneurysm After Kidney Transplantation: Two Case Reports. Transplant Proc. 2017; 49: 906-912. Ref.: https://goo.gl/uUE1UG
  17. Nie ZL, Zhang KQ, Li QS, Jin FS, Zhu FQ, et al. Treatment of urinary fistula after kidney transplantation. Transplant Proc. 2009; 41: 1624-1626. Ref.: https://goo.gl/iU87kT
  18. Mah TJ, Mallon DH, Brewster O, Saeb-Parsy K, Butler AJ, et al. Ureteric complications in recipients of kidneys from donation after circulatory death donors. Clin Transplant. 2017; 31. Ref.: https://goo.gl/3v3sqP
  19. Ham YR, Moon KR, Bae HJ, Ju HJ, Jang IK,et al. A Case of Urine Leakage: An Unusual Complication after Renal Biopsy. Chonnam Med J. 2011; 47: 181–184. Ref.: https://goo.gl/c39b5W
  20. Bzoma B, Kostro J, Hellmann A, Chamienia A, Hać S, et al. Ureteric Stenting in Kidney Transplant Recipients, Gdansk Centre Experience, Poland. Transplant Proc. 2018; 50: 1858-1862. Ref.: https://goo.gl/5ZGQm6
  21. Thompson ER, Hosgood SA, Nicholson ML, Wilson CH. Early versus late ureteric stent removal after kidney transplantation. Cochrane Database Syst Rev. 2018; 1: CD011455. Ref.: https://goo.gl/JAq67V
  22. Singer J, Gritsch HA, Rosenthal JT. The transplant operation and its surgical complications. In: Danovitch GM, ed. Handbook of Kidney Transplantation.5th ed. Philadelphia, PA, Lippincott Williams & Wilkins; 2005: 193-212.
  23. Duty BD, Barry JM. Diagnosis and management of ureteral complications following renal transplantation. Asian J Urol. 2015; 2: 202-207. Ref.: https://goo.gl/i9Xp3A
  24. Duty BD, Conlin MJ, Fuchs EF, Barry JM. The current role of endourologic management of renal transplant complications. Adv Urol. 2013; 246520. Ref.: https://goo.gl/eG2ny9
  25. Craggs B, Michielssen D. Conservative treatment of an intraperitoneal bladder perforation. Cent European J Urol. 2011; 64: 47–49. Ref.: https://goo.gl/Bdh5pD
  26. Burks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol 2014; 6: 115–124. Ref.: https://goo.gl/1uX9K7
  27. Yap R, Madrazo B, Oh HK, Dienst SG. Perirenal fluid collections after kidney transplantation. Chonnam Med J. 2012; 48: 57-59. Ref.: https://goo.gl/izQ1KR
  28. Kumar S, Ameli-Renani S, Hakim A, Jeon JH, Shrivastava S, et al. Ureteral obstruction following renal transplantation: Causes, Diagnosis and Management. Br J Radiol. 2014; 87: 20140169. Ref.: https://goo.gl/y7XZFp
  29. Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, et al. Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 2003; 23: 1133-1147. Ref.: https://goo.gl/zRDSXZ
  30. Poyraz NY, Ozdemir E, Keskin M, Türkölmez S. Additional Value of SPECT/CT to Tc-99m MAG3 Renal Scintigraphy in the Diagnosis of a Patient with Ureteroileal Fistula. Mol Imaging Radionucl Ther. 2012; 21: 84-87. Ref.: https://goo.gl/giQaRB