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Risk Factors for Early Urologic Complications after Kidney Transplantation
*Amir A. Rahnemai-Azar1, Brian F. Gilchrist1, *Liise K. Kayler2
1Bronx-Lebanon Hospital, Albert Einstein College of Medicine, New York City, NY;2Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY
Objective: Urologic complications are the most common adverse outcomes following kidney transplantation (KTX). We evaluated traditional and novel potential risk factors for urinary complications following kidney transplantation.
Design: Cohort
Setting: Referral center, Institutional practice
Patients: From our institution KTX database, consecutive KTX recipients between December 1, 2006 and December 31, 2010 with at least 6 months follow-up (n=635) were included in our study.
Main outcome measure (s): The included patients were evaluated for overall urinary complications accounting for donor, recipient, and transplant characteristics using univariate and multivariate logistic regression.
Results: Urologic complications occurred in 29 cases (4.6%) at a median of 40 days (range 1-999) post-transplantation. These complications include 17 (2.6%) ureteral strictures, 5 (0.8%) ureteral obstructions due to donor-derived stones or intra-urinary hematoma, and 7 (1.1%) urine leaks. All but 2 complications occurred within the first year of transplantation. Risk factors for urinary complications on univariate analysis were dual kidney transplantation (p =0.04, 95% CI), African-American recipient (p=0.04, 95% CI), and renal artery multiplicity (p=0.02, 95% CI). On multivariate analysis, only renal artery multiplicity remained significant (AHR 2.4, [95% CI 1.1, 5.1], p=0.02). Donation after cardiac death, non-mandatory national share kidneys, donor peak serum creatinine > 1.5 mg/dl or creatinine phosphokinase > 1000 IU/L, and donor down time were not associated with urinary complications.
Conclusion: Our data suggest that donor artery multiplicity is an independent risk factor for urinary complications following KTX. However, being African-American or receiving dual kidney transplantation do not place patient at higher risk of urinary complications following KTX transplant.
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