در تشخيص و درمان عوارض جراحي پيوند كليه PCN

PCN in Diagnosis and Treatment of Surgical Complications of Kidney Transplantation

Objective: Evaluation of percutaneous nephrostomy (PCN) in the diagnosis and primary treatment of surgical complications of kidney transplantation. Materials and Methods: We performed 1402 living donor heterotopic kidney transplants. 93.1% of donors were unrelated, mean age was 38.53 years. Male/females ratio was 1.7211. We reviewed patients who had hydronephrosis, uremia or urinary leakage in the follow-up period and needed PCN, we treated 21 patients with PCN (11 lymphoceles, 2 Uretero Neo Cystostomy (UNC) obstructions, 8 obstructive stones) and in all patients obstruction was relieved and creatinine levels dropped to preobstruction level without infection or other complications. Results: Average follow up period was 34.2 months. In this period mortality was 40 (2.9%). Graft loss was 135 (9.6%) and average creatinine level in patients with active graft was 1.43±0.71 mg%. Lymphoceles in all patients were treated by cutaneous drainage alone for 21 to 70 days. In late UNC obstruction, PCN relieved obstruction and stablized creatinine. We performed antegrade dilatation of UNC and stenting of ureter for 3 months. We performed Extro Corporol Shock Wove Lithothripsy (ESWL) after PCN in 8 patients with obstructive stones. In 6 patients the stones passed and in 2 patients we used nephroscopy and Per Cutaneous Nephro Lishotomy (PCNL) Conclusion: PCN is the modality of choice for all obstructive complications of kidney transplants. It has important role in diagnosis of etiology of obstruction and is excellent option for treatment of etiologic factors of obstruction without significant complications. We recommend PCN as a less invasive method for diagnosis and temporary treatment of obstructive complications of kidney transplantion without significant complications.