1. Ureteral Stenosis after Kidney Transplant Jonathan B. Yuval MD

2. case 23 YOF Idiopathic renal failure Renal Tx on 27/4/13 from a live donor Normal operative course (ischemia of in upper pole) Normal immediate post-op course

3. case One month after Tx readmitted d/t elevevated Cr Hydronephrosis on US Retrograde pyelography demonstrated a ureteral stricture Underwent nephrostomy insertion

4. case 5/2013 insertion of stent from renal pelvis to urinary bladder + Nephrostomy 6/2013 Urosepsis w/ KP. IV ABX. Closure of Nephrostomy. 7/2013 Endo-urological Tx of stenosis 7/2013 UTI w/KP. IV ABX. Closure of Nephrostomy. Prophylactic fosfomycin. 9/2013. Anterograde nephrostogram. Removal of stent. Removal of Nephrostomy.

5. case 9/2013 Elevated Cr. ESBL in urine. IV ABX. Improvement of Cr. 10/2013 in Dr. Merhav’s clinic. No Sx of UTI. Normal Cr.

7. Urological complications are the most common Stenosis/Leak in 5% of cases:

8. The transplanted ureter is susceptible to stenosis d/t poor blood supply Most common cause of mechanical obstruction DDX: Stones, Rejection, BKV, external compression

9. Increased peri-op morbidity and re-operation Does not affect graft survival if treated early

10. Risk Factors Donor Age Number of transplanted arteries CIT Method of organ retrieval Preservation of gonadal vessels Technique (UU/intravesical/extravesical) Ureteral stent Preservation of peri-pelvic/ureteric fat

11. Tx Endo-Surgery Surgical options – Re-insertion – Reconstruction w/native ureter – Pyelo-ureterostomy – Vesiculo-pyelostomy – Uretero-urererostomy – Reconstruction/Elongation of the bladder – Ileal interposition – Artificial ureter interposition

12. Thanks!!