21 May 2009
Kidney transplantation in adults with an ileal conduit formation – experience of the only one centre in PolandA Chmura, A Borkowski, W Rowiński, P Radziszewski, J Trzebicki, A Kwiatkowski
Ann Transplant 2009; 14(1): 52-52 :: ID: 880390
Background: Dialyzed patients with serious pathology of the lower urinary tract (LUT) had not been qualified for kidney transplantation in Poland until 1999, when the program of transplantation of such patients had begun in our institution. Aim: to compare the results to standard kidney transplantation.
Material/Methods: Since 1999 we have performed 22 kidney transplantations with an ileal conduit formation as urinary diversion. Out of 17 cadaveric and 5 living-related transplantations 2 ileal conduits had been performed prior to transplantation, 14 others at the time of the procedure. 2 kidneys were placed on the left, 20 on the right, positioned up-side down, with ureter anastomosed to the ileal loop, fashioned by dissecting 17cm of ileum near caecum; bowel was immediately anastomosed, restoring the digestive tract. The deep end of the conduit was closed, while the other was brought out as a cutaneous stoma. The ureter was then anastomosed to the blind end of the conduit supported by a "pig tail" catheter brought out through the stoma for 10-14 days post transplantation.
Results: During the follow-up ranging from 1 to 9 years, all but 3 kidneys survived with an excellent function (one kidney was lost due to massive fibrosis of the ureter in a patient with severe CMV infection, the second due to massive urinary infection with sepsis-both a year post transplantation; the third was lost 5 year post-tx as a result of chronic rejection). Several complications like ileus, ureter or loop necrosis, wound infection, haematuria and UTI all were treated successfully. Mean creatinine level was 1.2mg% for living-related kidney grafts and 1.4mg% for cadaveric kidneys.
Conclusions: Kidney transplantation in patients with urinary diversion through an ileal conduit is a safe and effective procedure in patients with serious LUT
pathology. Higher incidence of UTI does not inï¬‚uence graft function.
Keywords: Kidney Transplantation
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