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Raghav Talwar, Tapan Sinha, Prem P. Varma, Shailesh C. Karan, Arjun Singh Sandhu, Gurwinder Singh Sethi, Anand Srivastava, Vineet Narang, Chander Mohan, Transplantation of kidney with retrocaval ureter: what are the pitfalls?, Nephrology Dialysis Transplantation, Volume 21, Issue 1, January 2006, Pages 230–231, https://doi.org/10.1093/ndt/gfi106
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Sir,
In India, nearly 80 000 new cases of end-stage kidney disease are diagnosed each year [1]. Therefore, donors with various types of anatomical anomalies are being accepted for transplantation. At present, there are no existing guidelines regarding acceptability of such donors although larger centres tend to be more liberal. We report our experience in one such case where a kidney from a live related donor with a retrocaval ureter was transplanted.
A 40-year-old male with end-stage kidney disease secondary to chronic glomerulonephritis was awaiting renal transplantation. His brother, aged 50 years and completely asymptomatic, came forward as a potential donor. Intravenous urography (IVU), done during the donor evaluation, was suggestive of retrocaval ureter on the right side. Inferior vena cavography (Figure 1) confirmed the diagnosis. The glomerular filtration rates (GFR) of the left and right kidney were 49.2 and 41.2 ml/min, respectively. Open right donor nephrectomy was done. On release of the clamps after vascular anastomosis in the recipient, there was progressive dilatation of the proximal ureter (Figure 2). The non-dilated segment of the ureter was trimmed until free peristaltic flow of urine was confirmed and only then implanted into the bladder over a Double–J stent. Post-operatively, the urine output was sluggish, associated with a marked increase in the dilatation of the transplanted ureter, which however responded to administration of Frusemide for 7 days. The need to administer repeated aliquots of Frusemide in the immediate post transplant period was possibly due to impaired peristalsis in the dilated segment of the ureter, which gradually recovered normal function, after the obstruction was relieved. A literature search revealed only one similar case in which Costea et al. [2] implanted the non-dilated portion of the retrocaval ureter into the bladder. In their report, the recipient developed obstruction and required revision of the ureteroneocystostomy.
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