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Stravodimos KG et al, 2012: Renal transplant lithiasis: analysis of our series and review of the literature

Stravodimos KG, Adamis S, Tyritzis S, Georgios Z, Constantinides CA
1st Department of Urology, Athens Medical School, Laiko Hospital, Athens, Greece


Abstract

BACKGROUND AND PURPOSE: Renal transplant lithiasis represents a rather uncommon complication. Even rare, it can result in significant morbidity and a devastating loss of renal function if obstruction occurs. We present our experience with graft lithiasis in our series of renal transplantations and review the literature regarding the epidemiology, pathophysiology, and current therapeutic strategies in the management of renal transplant lithiasis.

PATIENTS AND METHODS: In a retrospective analysis of a consecutive series of 1525 renal transplantations that were performed between January 1983 and March 2007, 7 patients were found to have allograft lithiasis. In five cases, the calculi were localized in the renal unit, and in two cases, in the ureter. A review in the English language was also performed of the Medline and PubMed databases using the keywords renal transplant lithiasis, donor-gifted lithiasis, and urological complications after kidney transplantation. Several retrospective studies regarding the incidence, etiology, as well as predisposing factors for graft lithiasis were reviewed. Data regarding the current therapeutic strategies for graft lithiasis were also evaluated, and outcomes were compared with the results of our series.

RESULTS: Most studies report a renal transplant lithiasis incidence of 0.4% to 1%. In our series, incidence of graft lithiasis was 0.46% (n=7). Of the seven patients, three were treated via percutaneous nephrolithotripsy (PCNL); in three patients, shockwave lithotripsy (SWL) was performed; and in a single case, spontaneous passage of a urinary calculus was observed. All patients are currently stone free but still remain under close urologic surveillance.

CONCLUSION: Renal transplant lithiasis requires vigilance, a high index of suspicion, prompt recognition, and management. Treatment protocols should mimic those for solitary kidneys. Minimally invasive techniques are available to remove graft calculi. Long-term follow-up is essential to determine the outcome, as well as to prevent recurrence.

J Endourol. 2012 Jan;26(1):38-44. doi: 10.1089/end.2011.0049. Epub 2011 Dec 5
PMID:22050494[PubMed - in process]

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Comments 1

Peter Alken on Saturday, 22 October 2011 08:57

The authors conclude that treatment protocols for renal transplant lithiasis should mimic those for solitary kidneys in general.

Peter Alken

The authors conclude that treatment protocols for renal transplant lithiasis should mimic those for solitary kidneys in general. Peter Alken
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