Complications of ureterovesical anastomosis in adult renal transplantation: Comparison of the Lich-Gregoire and the Taguchi techniques
Ahmad Ameer, Murad Aljiffry, Mohammad Jamal, Mazen Hassanain, Suhail Doi, Myriam Fernandez, Peter Metrakos, Marcelo Cantarovich, Prosonto Chaudhury, Jean Tchervenkov
Ann Transplant 2011; 16(3): 82-87
Background: Our aim is to identify the incidence of urologic complications in adult renal transplantation comparing two different ureterovesical anastomosis techniques, the Taguchi (T) and Lich-Gregoire (LG).
Material/Methods: Retrospective analysis of adult renal transplants performed at the MUHC between 2000–2009. Excluded: multi-organ transplants, re-do transplants, variant ureteric anastomosis and patients received grafts from UNOS ECD. 372 patients were analyzed. 209 patients (56%) in the T group and 163 patients (44%) in the LG group. Fisher’s exact test was used to compare the groups for urologic complications. A multivariate analysis was performed to identify factors associated with graft rejection and death.
Results: 21 patients developed a urinary leak or stricture. A total of 13 patients (3.4%) developed ureteric strictures and 9 (2.4%) patients developed urinary leak with no difference in urinary leak or stricture between both groups (p=1). Hematuria requiring intervention developed in 55 patients. A higher incidence of complicated hematuria in the T group when compared to the LG group (37 vs. 18, p=0.079)). No differences in other ureteric complications between the 2 groups. Delayed graft function OR=3.4 (95% CI=1.8–6.3) and grafts from a deceased donors OR=2.2 (95% CI=1.1–4.5) are factors associated with graft loss. Factors associated with first episode of rejection include delayed graft function OR=2.4 (95% CI=1.3–4.4), and the development of ureteric stricture OR=3.9 (95% CI=1.8–8.7).
Conclusions: Both techniques can be used interchangeably for adult renal transplantation. T technique is associated with a greater risk of hematuria. Ureteric strictures are associated with a shorter time to first graft rejection.
Keywords: Kidney Transplantation, Taguchi method, Lich-gregoire technique