Urological Complications in Kidney Transplantation

Abstract

The kidney is an essential organ that plays an crucial role in acid-base balance, sodium and potassium balance, calcium metabolism, regulation of blood pressure, red blood cell synthesis and excretion of metabolites. Kidney diseases may result in kidney failure with the requirement of kidney replacement therapy like dialysis. Hemodialysis and peritoneal dialysis may extend patient survival but does not cure the kidney failure. Kidney transplantation is considered the optimal kidney replacement therapy for patients with end stage kidney failure, resulting in decreased morbidity, improved quality of life and higher costs effectiveness when compared to dialysis. In the early years of experimental kidney transplantation, donor kidneys were placed in the thigh with cutaneous ureterostomy drainage or in the iliac fossa with drainage by ureteroureterostomy to the recipient native ureter. In January 1951, Rene Kuss placed a donor kidney into the iliopelvic region of the recipient with cutaneous ureterostomy.1, 2 Soon thereafter another French surgical team established the concept that a kidney placed in the iliac fossa provides a short ureter with possibilities for drainage to the bladder. Although these early attempts of kidney transplantation resulted in failure, Joseph Murray and John Hartwell Harrison completed the first successful kidney transplantation on identical twins in Boston on December 23, 1954.3 The recipient was prepared with hemodialysis, and monozygosity was confirmed by the successful exchange of full thickness skin grafts between the twins. The left donor kidney was transplanted in the right recipient’s iliac fossa, and a intravesical ureteroneocystostomy with a submucosal tunnel was established. A small polyethylene catheter was placed up the transplant ureter and was suprapubicly externalized. After renal vascularization by doctor Murray, doctor Harrison assisted with the urinary tract reconstruction. The kidney functioned directly after transplantation and the patient was discharged on day 37 postoperative. The kidney function maintained good and was functioning until cardiac death 8 years later occur.4 This successful transplantation between identical twins enhanced the opinion that the pelvic location with possibilities of bladder drainage was the most physiological and natural position for the kidney graft.1 Nevertheless, the intervention of adequate immunosuppressive therapy in the 1960s enabled kidney transplantation on a larger scale.