Treatment of urological complications in more than 1,000 kidney transplantations: the role of interventional radiology

PURPOSE: The aim of this study is to evaluate the efficacy and safety of interventional radiology procedures in the treatment of major urological complications after kidney transplantation. MATERIALS AND METHODS: Between 2000 and 2010, 1,146 kidney transplants were performed at our institution. A total of 146 major complications occurred, including 77 obstructions, 36 leaks and 33 associated perigraft fluid collections. Percutaneous treatment was carried out in 118/146 complications in 91 patients. In the case of stenosis-obstruction and fistulas (104 complications), the first therapeutic step was placement of a nephrostomy catheter, followed by balloon ureteroplasty, placement of external-internal catheters and double-J stents; 14/33 collections were drained under ultrasound guidance. RESULTS: In all 118 percutaneous interventions, we were able to place a nephrostomy or drainage catheter, with a technical success rate of 100 %. The long-term success rate was 49.6 %: in 57/115 (three patients were lost to follow-up) we obtained the complete resolution of the complication. The procedure-related mortality rate was 0 %. There was only one major complication and the rate of minor complications was 14.4 %. CONCLUSIONS: Interventional radiology is the first choice option in the treatment of urological complications after kidney transplantation.