[Partial transplantectomy combined with substitution of the urinary tract, in the treatment of segmental renal infarction after transplantation].

OBJECTIVES

To present our experience with post-transplantation necrotic infarction involving large areas of the renal parenchyma, causing caliceal fistula, and the therapeutic possibilities aimed at achieving graft survival.

METHODS

690 kidney transplants were reviewed: of these 6 had post-transplantation segmental renal infarction with subsequent parenchymal necrosis involving 25 to 40% of the organ and associated with urinary tract necrosis in two cases. The patients were treated conservatively by partial graft resection, the calyces were closed separately and the lining repaired with vascularized parietal peritoneal flaps or lyophilized patches of human dura mater sealed with fibrin glue and substitution of the necrotic urinary tract in two cases.

RESULTS

One patient died a few minutes after the operation from cardiorespiratory causes. In the remaining 5 patients, the fistula was resolved definitively. Five years postoperatively, the salvaged parenchyma is functioning well and dialysis has not been required.

CONCLUSIONS

Partial graft resection, followed by separate closure of the calyces, lining repair with parietal peritoneum or lyophilized human dura and fibrin glue and substitution of the urinary tract, if compromised by necrosis can salvage renal grafts with wide areas of necrosis.