TY - JOUR
T1 - Donor kidney lithiasis and back-table endoscopy: a successful combination
AU - Henderickx, Michaël M. E. L.
AU - Baard, Joyce
AU - Wesselman van Helmond, Pauline C.
AU - Jansen, Ilaria
AU - Kamphuis, Guido M.
N1 - Publisher Copyright: © 2021 The Royal Belgian Society for Surgery.
PY - 2021
Y1 - 2021
N2 - Introduction: Urolithiasis in renal allografts is relatively rare with an incidence of 0.17–4.40%. It is nonetheless an important issue, as there is a risk of obstruction, sepsis and even loss of the renal allograft. The management of stones in renal allografts remains challenging because of the anatomy, the renal denervation and the use of immunosuppressive medication. Case presentation: This report discusses the ex-vivo treatment of asymptomatic nephrolithiasis in a living donor kidney allograft. A CT abdomen revealed a lower pole stone (5.9 × 5.5 × 5.0 mm; 920 HU) in the right kidney of the potential donor. After multidisciplinary discussion, it was decided to procure the right kidney despite the presence of a documented nephrolithiasis. After discussion with both donor and recipient, an ex-vivo flexible ureterorenoscopy for stone removal on the back table just before implantation of the allograft was planned. The stone was found in the lower pole covered by a thin film of the urothelium. The thin film of urothelium was opened with a laser and the stone fragments were retrieved with a basket. CT after one month showed no residual stones in the transplanted kidney. Conclusion: Back-table endoscopy in a renal allograft is a feasible technique and should be discussed as an option in case of urolithiasis in a kidney that is considered for transplantation. Furthermore, the appropriate treatment of donor kidney lithiasis is another, although rare, method to expand the living donor renal allograft pool.
AB - Introduction: Urolithiasis in renal allografts is relatively rare with an incidence of 0.17–4.40%. It is nonetheless an important issue, as there is a risk of obstruction, sepsis and even loss of the renal allograft. The management of stones in renal allografts remains challenging because of the anatomy, the renal denervation and the use of immunosuppressive medication. Case presentation: This report discusses the ex-vivo treatment of asymptomatic nephrolithiasis in a living donor kidney allograft. A CT abdomen revealed a lower pole stone (5.9 × 5.5 × 5.0 mm; 920 HU) in the right kidney of the potential donor. After multidisciplinary discussion, it was decided to procure the right kidney despite the presence of a documented nephrolithiasis. After discussion with both donor and recipient, an ex-vivo flexible ureterorenoscopy for stone removal on the back table just before implantation of the allograft was planned. The stone was found in the lower pole covered by a thin film of the urothelium. The thin film of urothelium was opened with a laser and the stone fragments were retrieved with a basket. CT after one month showed no residual stones in the transplanted kidney. Conclusion: Back-table endoscopy in a renal allograft is a feasible technique and should be discussed as an option in case of urolithiasis in a kidney that is considered for transplantation. Furthermore, the appropriate treatment of donor kidney lithiasis is another, although rare, method to expand the living donor renal allograft pool.
KW - Back-table endoscopy
KW - endourology
KW - nephrolithiasis
KW - renal allograft
KW - renal transplant
UR - http://www.scopus.com/inward/record.url?scp=85107431973&partnerID=8YFLogxK
U2 - https://doi.org/10.1080/00015458.2021.1934333
DO - https://doi.org/10.1080/00015458.2021.1934333
M3 - Article
C2 - 34034616
SN - 0001-5458
JO - Acta chirurgica Belgica
JF - Acta chirurgica Belgica
ER -