ÜRETER DUPLİKASYONLU GREFT BÖBREKLERDE NAKİL TECRÜBEMİZ

Amaç Kronik böbrek yetmezliğinin en etkili tedavisi böbrek naklidir. Böbrek nakli sonrası ürolojik komplikasyonlar morbiditeyi arttırmaktadır. Üreter duplikasyonu (ÜD), böbrek donörlerinde üst üriner sistemin en sık görülen anomalisidir. ÜD prevalansı % 0.6 - % 1 arasında değişmektedir. ÜD’li böbrek greftlerinde yapılacak üreter-mesane anastomoz tekniği ile ilgili görüş birliği yoktur. Bu çalışmamızda, kliniğimizde yapılmış olan ÜD’ li renal transplantasyon tecrübelerimizi ve sonuçlarımızı paylaşmayı amaçladık.Gereç ve Yöntem Ocak 2013 - Aralık 2017 tarihleri arasında Antalya Medicalpark Organ Nakli Bölümü’nde ÜD’li greft böbrek ile nakil 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 nakli öncesi diyaliz türleri, böbrek nakli sayısı, böbrek nakli sonrası üriner komplikasyonlar, kreatinin düzeyi, greft sağ kalımı, hasta sağ kalımı 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 (8y-60y), erkek/kadın oranı 1.1’di. Böbrek alıcılarının 15’i erkek 13’ü kadın, böbrek donörlerinin 22’si canlı, 6’sı kadavraydı. Donörlerde kadın/erkek oranı 3 olarak saptandı. Ortalama donör yaşı 48.6 ± 15.5 (14y-81y) olarak belirlendi. On üç hasta preemptif, 14 hasta hemodiyaliz alırken 1 hasta da periton diyalizi yapmaktaydı. Ortalama ameliyat süresi 80.6 ± 13.4 dk (65dk-109dk) ölçüldü. Bir hastada böbrek nakli sonrası 2. ayda idrar kaçağı oluştu (%3,5). Diğer hastalarda üriner komplikasyon saptanmadı.Sonuç Böbrek nakil ameliyatlarında greft böbreklerde ÜD, böbrek nakli için engel kabul edilmemelidir. Tecrübelerimize göre ÜD olan greft böbreklerde tek ostiumlu Lich Gregoir üreteroneosistostomi yönteminin 2 adet double-j stent kullanılarak yapılması diğer yöntemlere göre daha güvenlidir.

OUR EXPERIENCE IN THE TRANSPLANTATION OF GRAFT KIDNEYS WITH URETER DUPLICATION

Objective The most effective treatment of chronic renal failure is kidney transplantation. Urological complications that seen after kidney transplantation increase the morbidity. Ureter duplication (UD) is the most common anomaly of the upper urinary tract in donor kidneys . 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. Material and 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 survival and patient survival were evaluated. Results Between January 2013 and December 2017, 2039 kidney transplantation 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 min (65min-109 min). Urinary leakage occurred in one patient (3.5%) within the 2 months after renal transplantation .There were no urinary complications in other patients. Conclusion 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 two double-j stents in the kidney grafts with UD is safer than other methods.

PDF

___

1. Ghazanfar A, Zaki MR, Pararajasingam R, Forgacs B, Tavakoli A. Outcome of kidney transplant with double ureter: a multicenter study. Exp Clin Transplant. 2015;13(2):152–6.
2. Lasaponara F, Dalmasso E, Bosio A, Pasquale G, Sedigh O, Santià S, et al. Kidney transplant grafts with complete ureteral duplication. Exp Clin Transplant. 2013 ;11(6):507–09.
3. Sulikowski T, Zietek Z, Ostrowski M, Kamiński M, Sieńko J, Romanowski M, et al. Experiences in kidney transplantation with duplicated ureters. Transplant Proc. 2005 ;37(5):2096–99.
4. Sarier M, Demir M, Goktas S, Duman I, Buyukkinaci M, Yuksel Y, et al. Results of Real-time Multiplex Polymerase Chain Reaction Assay in Renal Transplant Recipients With Sterile Pyuria. Transplant Proc. 2017 ;49(6):1307–11.
5. Alberts VP, Minnee RC, van Donselaar–van der Pant KAMI, Bemelman FJ, Zondervan PJ, Laguna Pes MP, et al. Duplicated Ureters and Renal Transplantation: A Case-Control Study and Review of the Literature. Transplantation Proceedings. 2013;45(9):3239–44.
6. Kayler L, Kang D, Molmenti E, Howard R. Kidney transplant ureteroneocystostomy techniques and complications: review of the literature. Transplant Proc. 2010 42(5):1413–20.
7. Sözen H, Onaran M, Özen O, Dalgıç A. Urologic Complications After Renal Transplant: A Single-Center Experience. Exp Clin Transplant. 2017
8. Dinckan A, Tekin A, Turkyilmaz S, Kocak H, Gurkan A, Erdogan O, et al. Early and late urological complications corrected surgically following renal transplantation. Transpl Int. 2007 ;20(8):702–07.
9. Haferkamp A, Dörsam J, Möhring K, Wiesel M, Staehler G. Ureteral complications in renal transplantation with more than one donor ureter. Nephrol Dial Transplant. 1999 ;14(6):1521–24.
10. Uchida J, Naganuma T, Machida Y, Kitamoto K, Yamazaki T, Iwai T, et al. Modified extravesical ureteroneocystostomy for completely duplicated ureters in renal transplantation. Urol Int. 2006;77(2):104–06.
11. Nagashima N, Saitoh N, Arai T, Watanabe T, Koyama I. Double ureteroneocystostomy for duplicated allograft ureters in renal transplantation. Transplant Proc. 2003 ;35(1):334–36.
12. Genyk Y, Knight R, deCsepel J, Burrows L. Successful transplantation of pediatric en bloc kidneys with bilateral double ureters. Transpl Int. 1999;12(4):281–82.
13. Alberts VP, Idu MM, Legemate DA, Laguna Pes MP, Minnee RC. Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis. Transpl Int. 2014 ;27(6):593–605.
14. Heidari M, Gharaati MR, Iran-Pour E, Simforoosh N, Zare S, Basiri A. Transplantation of kidneys with duplicated ureters. Scand J Urol Nephrol. 2010 ;44(5):337–40.
15. Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, et al. Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation. Transplant Proc. 2017 ;49(3):523–27.
16. Birkan Bozkurt MT. Modified Extravesical Ureteroneocystostomy in Cadaveric Kidney Transplantation with Completely Duplicated Ureters: A Case Report. Journal of Transplantation Technologies & Research. 2014;04(02). (http://omicsonline. org/open-access/modified-extravesical-ureteroneocystostomy-in-cadaveric-kidney-transplantation-with-completely-duplicated-ureters-a-case-report-2161-0991.1000131.php?aid=26341 adresinden ulaşılmıştır).
17. Salamanca-Bustos JJ, Gomez-Gomez E, Campos-Hernández JP, Carrasco-Valiente J, Ruiz-García J, Márquez-López FJ, et al. Initial Experience in the Use of Novel Auto-expandable Metal Ureteral Stent in the Treatment of Ureter Stenosis in Kidney Transplanted Patients. Transplant Proc. 2018 ;50(2):587–90. Süleyman