Extensive Ureteral Stricture in Renal Transplant Recipients: Prevalence and Impact on Graft and Patient Survival

Extensive ureteral stricture (EUS) after renal transplantation (RTx) is an important urological complication that adversely affects the longterm function of the allograft and therefore the morbidity and mortality of the recipients. We conducted this study to determine the prevalence of the EUS in RTx recipients and its impact on the patient and graft survival. We assessed retrospectively, 1450 patients who underwent renal transplantation by a fixed surgical team between December 1991 and December 2009 at Emam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran. EUS was diagnosed in 13 (1.1%) patients including 8 (61.5%) male. The mean±SD age of patients at the time of surgery was 33.6±13.7 years; the length of follow-up was 77.9±63.5 months; and the ischemic time was 126.5±114.1 min. Mostly, EUS was noticed in recipients of transplants with more than one artery (p<0.05) and of cadaveric donors with more than 4 hour ischemic time (p<0.001). In follow-up, after ureteropyelostomy (7 cases), ipsilateral pyelopyloplasty (4 cases) and contralateral pyelopyeloplasty (2 cases), no evidence of ureteral stricture recurrence, graft loss or death was observed. We concluded that the incidence of EUS, as a urologic complication after RTx is very low. The advanced techniques of RTx that preserve the ureteric blood supply and the better procedures for ureteral reconstruction have improved the survival rate of patient and graft.