Korean J Transplant.  2022 Nov;36(Supple 1):S383. 10.4285/ATW2022.F-5219.

Outright antegrade ureteral stent insertion on an allograft kidney with angiomyolipoma with immediate obstructive uropathy posttransplant

• Liquete MM
• Joven AC
• Duque A

• KMID: 2535221
• DOI: http://doi.org/10.4285/ATW2022.F-5219

Abstract

Background
Kidney allograft ureteral obstruction may occur on the first few weeks to the first year posttransplant. It may be due to intrinsic obstruction, extrinsic compression, ureteral ischemia or kinking of the ureter. Once identified, prompt interven-tion should be done to prevent allograft dysfunction and graft loss. Aside from nephrostomy tube insertion, retrograde stent insertion may be done, although this poses a challenge. Upon improvement of renal function, definitive treatment is done such as percutaneous balloon dilation followed by antegrade stent placement. Surgical revision is recommended for recurrence. We described a case of a 22-year-old female with chronic glomerulonephritis having standard immunologic risk, who received a kidney from a living related donor who developed ureteral obstruction on the first week posttransplant. She underwent outright antegrade ureteral double-J stent insertion. The kidney was also found to have a 0.6 cm angiomyolipoma on the superior pole seen on computed tomography angiogram.
Methods
Data from this report is obtained from daily chart entries.
Results
After an unremarkable kidney transplant, the patient had no urine output 5 days postoperation. On magnetic resonance imaging (MRI), there was a 100 cc fluid collection impinging on the ureter. He underwent allograft exploration and evacuation of 200 cc hematoma. However on the second day post-exploration, there was recurrence of no urine output. Repeat MRI showed dilated collecting system. Under ultrasound guidance, the superior pole of the kidney was punctured and the tract dilated. An-tegrade pyelogram showed moderately dilated collecting system. There was an abrupt narrowing on the middle third segment of the ureter. Guidewire was able to pass through and a ureteral double j stent was inserted. There was marked improvement on the urine output and the creatinine of the patient postoperation.
Conclusions
Outright antegrade ureteric stent placement is possible resulting to improvement on allograft function. Monitor-ing will be done the kidneys angiomyolipoma.