ÜRETER DUBPLİKASYONLU GREFT BÖBREKLERDE NAKİL TECRÜBEMİZ

ÜRETER DUPLİKASYONU OLAN GREFT BÖBREKLERDE BÖBREK NAKLİ TECRÜBEMİZ Amaç: Kronik böbrek yetmezliğininin en etkili, tedavisi böbrek naklidir . Böbrek nakli sonrası ürolojik komplikasyonlar, morbiditeyi arttırmaktadır . Üreter duplikasyonu ( ÜD), üst üriner sistemin en sık görülen anomalisidir . ÜD prevalansı, % 0.6-% 1, arasında değişmektedir. ÜD’lu böbrek greftlerinde yapılacak üreter mesane anastomuzunun nasıl yapılacağı ilgili görüş birliği yoktur. Bu çalışmamızda, kliniğimizde yapılmış olan ÜD'lu renal transplantasyon tecrübelerimizi ve sonuçlarımızı paylaşmayı amaçladık. Gereç ve Yöntem: Ocak 2013- Aralık 2017 tarihleri arasında Antalya Medicalpark Organ Nakli Bölümünde ÜD’li greft böbrek ile böbrek nakli yapılan hastaların sonuçları retrospektif olarak analiz edildi. Hastaların yaş, cinsiyet, donör türü, donör yaşı, donör ameliyatının tipi, böbrek nakli sonrası takip süresi, ortalama ameliyat süresi, böbrek nakliöncesi dializ türleri, böbrek nakli sayısı, böbrek nakli sonrası üriner komplikasyonlara, kreatinin düzeyi, greft sağ kalımı ile birlikte hasta sağ kalımına değerlendirildi. Bulgular: Merkezimizde ocak 2013- aralık 2017 tarihleri arasında 2039 böbrek nakli yapıldı. Olguların 28 (% 0,1)’inde ÜD saptandı. Hastaların ortalama yaşı 38 .07 ±14.7 (range 8-60). Erkek kadın oranı 1.1 di. Böbrek alıcılarının 15’i erkek 13'ü kadındı, böbrek donörlerinin 22'si canlı 6'sı kadavraydı. Donörlerde (kadın, erkek )oranı 3 saptandı. Ortalama donör yaşı 48.6 ± 15.5 (14-81) di. 13 hasta preemptif, 14 hasta hemodializ, 1 hasta da periton dializi yapmakta idi. Ortalama ameliyat süresi 80.6±13.4 dakika (65-109). Bir hastada böbrek nakli sonrası 2. ayda idrar kaçağı oluştu (%3.5). Diğer hastalarda üriner komplikasyon saptanmadı. Sonuç: Böbrek naklinde greft böbreklerde ÜD böbrek nakli için engel kabul edilmemelidir, tecrübelerimize göre ÜD olan greft böbreklerde tek ostiumlu Lich Gregoir Üreteroneosistostomi, yöntemi, 2 adet DJS kullanılarak yapılması, diğer yöntemlere göre daha güvenlidir. Anahtar Kelimeler: Böbrek Transplantasyonu, Üreter dublikasyonu, Üreteroneosistostomi, Komplikasyon OUR EXPERİNCE WİTH KİDNEY TRANSPLANTAİON IN KIDNEYS WİTH URETER DUPLİCATİON Purpose: The most effective treatment of chronic renal failure is kidney transplantation. Urological complications after kidney transplantation increase morbidity. Ureter duplication (UD) is the most common anomaly of the upper urinary tract. . There is no consensus on how to perform ureter bladder anastomosis in kidney grafts with double ureters. In this study, we aimed to share our experience and results of renal transplantation with grafts having UD anomaly performed in our clinic.Methods: Between January 2013 and December 2017, the results of transplantations at Antalya Medical Park Transplantation Center with kidney grafts which had ureteral duplication were analyzed retrospectively . Age, sex, donor type, age of donor, type of donor operation, duration of renal transplantation, mean operation time, pre-renal dialysis types, number of kidney transplants, urinary complications after kidney transplantation, creatinine level, graft surviv and patient survival were evaluatedResults: Between January 2013 and December 2017, 2039 kidney transplants were performed in our transplantation center. UD was detected in 28 cases (0.1%). The mean age of donors was 48.6 ± 15.5 (14-81). The mean operative time was 80.6 ± 13.4 minutes (65-109). Urinary leakage occurred in one patient (3.5%) within the 2 months after renal transplantation .There were no urinary complications in other patientsConclusion:In renal transplantation, the graft with ureteral duplication should not be considered as an obstacle for renal transplantation .We experienced that Lich Gregoir Ureteroneocystostomy method with single-ostium by using 2 Double –J stents in the kidney grafts with UD is safer than other method. Keywords: Kidney transplantion, Ureter duplication Ureteroneocystostomy, Complications

Anahtar Kelimeler:

Böbrek Transplantasyonu, Üreter Duplikasyonu, Üretereneosistostomi, Komplikasyon

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