Wong KA et al, 2013: Management of stones in renal transplant
Wong KA, Olsburgh J
Renal Transplant and Urology Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
PURPOSE OF REVIEW: Increasingly, screening of both deceased and living donor organs has led to the early detection of kidney stones prior to donation. A number of transplant recipients will still present with donor-gifted and de-novo stones. A range of treatment modalities is available in the management of renal transplant stones.
RECENT FINDINGS: Stones can be pretreated in the (living) donor prior to transplantation, managed at the time of transplantation or treated in the recipient post-transplant. The options include conservative management, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, ureteroscopy or open surgery depending on the size and location of the stone(s). Various techniques to deal with a transplant kidney are described. Ex-vivo ureteroscopy or pyeloscopy can safely render a kidney-stone free prior to transplantation and in living donors this means without subjecting the living donor to an additional stone removing procedure.
SUMMARY: The cause of renal transplant lithiasis is multifactorial. More research is needed to understand the factors associated with de-novo stone formation. Early detection of donor-gifted stones can allow stones to be removed at the time of transplantation. Close follow up of both living donors and transplant recipients is necessary to ensure long-term safety is maintained.
Curr Opin Urol. 2013 Mar;23(2):175-9. doi: 10.1097/MOU.0b013e32835d3097
PMID:23287460 [PubMed - in process]
Treating stones in transplanted kidneys is a delicate procedure and great care should be exerted in order to reduce the tissue trauma to a minimum. SWL is an attractive treatment modality because URS in the retrograde way can be difficult due to the anatomical position of the ureteral orifice. PNL is more traumatic but of course an option in patients with a nephrostomy catheter in place.
It seems highly important, however, to exclude patients with uric acid stones from active stone removal. A careful metabolic workup is mandatory particularly because the levels of urate excreted in transplanted patients is high and it is my own experience that patients with transplanted kidneys often have uric acid stones that best can be treated pharmacologically.