Secondary ureteropyelostomy in renal transplant recipients.

Ischemic necrosis of the allograft ureter after renal transplantation most often results from failure to preserve adequately is vascularity during donor nephrectomy. An acute episode of rejection occurring within the first few weeks postoperatively may serve to compound the problem, producing even more extensive necrosis of the urinary collecting system. Secondary ureteropyelostomy using the recipient's own ipsilateral ureter is the salvage operation of choice in this situation and can be highly successful provided there is strict adherence to a number of important surgical principles.