Surgical complications in 1000 renal transplants

There were 154 (15.4%) postoperative surgical complications. The urological complications were as follows: urinary obstruction in 31 (3.1%) patients, ureteral fistulae in 25 (2.5%), and distal ureteral necrosis in 4 (0.4%). There were 2 (0.2%) vesical ruptures, 1 calcification of the stent, and 1 broken stent after traction. Twenty-four of the 25 fistulae occurred within 4 weeks after transplantation, while the interval to onset of obstruction ranged from 10 days to 11 years. Obstructions were cured by open surgery in 23 cases, by endoscopic incision in 4 cases, and by temporary stenting in 4 others. Among the patients with urinary leakage, 23 were treated surgically and 2 conservatively (Table 1). Vascular complications developed after 14 (1.4%) transplants: 6 (0.6%) renal artery thromboses, 3 (0.3%) venous thromboses, 2 artery aneurysms, 1 arterial stenosis, 1 arterial kinking, and 1 arterial dissection. All patients were reoperated. The lymphoceles that occurred in 26 (2.6%) patients were mostly treated conservatively, with only 6 cases requiring surgical drainage. There were 50 (5.0%) wound-related complications: 32 wound hematomas and 18 wound infections. Overall, seven (0.7%) grafts were lost, all due to vascular complications (5 to arterial thrombosis and 2 to venous thrombosis), despite early surgery. One patient died of septicemia after a urinary obstruction. The actuarial graft survival rates at 1, 3, 5, 10, and 15 years are 92%, 86%, 78%, 60%, and 50%, respectively.