Urologic complications in renal transplant recipients by donor type.

BACKGROUND AND PURPOSE: Reduced donor morbidity has been established after laparoscopic donor nephrectomy compared with open harvest, but differences in recipient outcomes remain less obvious. We compared the urologic complications in patients receiving kidneys procured by cadaveric, open, and laparoscopic harvest. PATIENTS AND METHODS: A retrospective study of all the kidney transplantations performed between January 1998 and December 2003 was undertaken to extract 100 consecutive patients in each group. All urologic complications were obtained and grouped by the type of donor procurement. RESULTS: Overall, 48 of the 276 transplant patients (17%) had urologic complications: 14% of the cadaveric-donor recipients, 20% of the open-donor recipients, and 18% of the laparoscopic-donor recipients. There were no ureteral complications in the laparoscopic group. CONCLUSIONS: Laparoscopically procured donor kidneys were associated with significantly fewer recipient ureteral complications than open cadaver or live-donor procurement.

Efficacy and morbidity of therapeutic renal embolization in the spectrum of urologic disease.

PURPOSE: We report the largest series of renal embolizations performed for a variety of indications. PATIENTS AND METHODS: A retrospective analysis was performed on embolizations performed in our institution from 1997 to 2002 encompassing 36 patients who underwent 44 procedures. RESULTS: Embolization was successful on the first attempt in 87% of the patients. A second embolization was performed in four of the five unsuccessful cases, three successfully, increasing the success rate to 95%. The mean postoperative narcotic use was 27.2 mg of morphine equivalent, and 10 mg or less was required by 45% of the patients. In the 14 patients who had not also undergone a surgical procedure, the mean narcotic use was 21 mg, and 64% required 10 mg or less. Only 15% of the patients developed fever, which resolved within 2 days in all cases. Leukocytosis was seen in 47%. Follow-up creatinine and hypertension information was available in 16 and 18 patients, respectively. After a mean follow-up of 269 days, only one patient had a clinically significant rise in the creatinine concentration. After a mean follow-up of 496 days, two patients had new-onset hypertension. There was no statistically significant difference in the success rate, narcotic use, complications, creatinine concentrations, or the likelihood of fever, leukocytosis, or hypertension according to the indication for embolization or the agent used. Use of a microcatheter was associated with less parenchymal loss, and decreased parenchymal loss was associated with a significant reduction of narcotic use. CONCLUSIONS: Renal embolization is a highly effective and well-tolerated procedure in a variety of urologic conditions. The indications and material used did not have a significant effect on the outcome. Reducing parenchymal loss can significantly reduce morbidity.