Ureteroneocystostomy contributes to late functional and morphological changes in rat kidney transplants

E. A. Kouwenhoven, R. W.F. De Bruin, U. W. Heemann, R. L. Marquet, J. N.M. Ijzermans

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Purpose: We investigated whether the surgical technique used to reconstruct the ureter has an impact on the late function of kidney transplants by comparing ureteroneocystostomy and ureteroureterostomy. To rule out alloantigeneic mediated effects on late graft dysfunction kidney transplants were performed in a syngeneic model. Materials and Methods: Rat kidney isografts were transplanted with simultaneous ureteroneocystostomy or ureteroureterostomy. Unilaterally nephrectomized rats served as controls. Eight weeks after transplantation intrapelvic pressure was measured during baseline diuresis, and after intravesical and intrapelvic infusion. Albuminuria was determined monthly until sacrifice at week 52. Histomorphological analysis included the degree of glomerulopathy, tubular atrophy, interstitial fibrosis and intimal hyperplasia. CD4+- and CD8+ T cells, and macrophages were identified using immunohistochemical testing. Results: Eight weeks after transplantation intrapelvic pressure during baseline diuresis and after intrapelvic infusion was significantly increased in rats with ureteroneocystostomy versus those with ureterostomy and unilateral nephrectomy, whereas intravesical infusion did not change the pressure in any group. During follow-up albuminuria after ureteroureterostomy did not differ from that after unilateral nephrectomy. In contrast, albuminuria significantly increased after ureteroneocystostomy from week 36 onward. At week 52 the ureter and kidney after ureteroureterostomy and unilateral nephrectomy had a normal appearance, whereas all ureters were dilated after ureteroneocystostomy. Nevertheless, 6 of the 8 kidneys in the ureteroneocystostomy group had a normal appearance. However, histomorphological findings in rats with transplants and ureterovesical anastomosis demonstrated significantly more interstitial fibrosis, CD8+ T cells and macrophages than isografts ureteroureterostomy. Conclusions: As a surgical technique for restoring the urinary tract after kidney transplantation, ureteroneocystostomy contributes to the development of long-term functional and histological renal changes. Partial obstruction may be the cause of this renal impairment.

Original languageEnglish
Pages (from-to)1700-1704
Number of pages5
JournalJournal of Urology
Volume165
Issue number5 I
DOIs
StatePublished - 2001
Externally publishedYes

Keywords

  • Iatrogenic disease
  • Kidney
  • Kidney diseases
  • Kidney transplantation
  • Ureteral obstruction

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