Living donor-gifted allograft lithiasis: surgical experience after bench surgery stone removal and follow-up

Abstract

This study presents the surgical experience and long-term outcomes of living donor kidney transplantations involving asymptomatic kidney stones, using ex vivo flexible ureterorenoscopy (f-URS) during bench surgery for stone removal. Out of 1743 living kidney donors assessed between January 2012 and October 2022, 18 (1%) were diagnosed with urolithiasis. Among them, 12 donors were rejected, and 6 were accepted for kidney donation. Stone removal was successfully performed using f-URS during bench surgery, with no immediate complications or acute rejections observed. The study analyzed six living kidney transplants, of which 4 (67%) donors and three recipients were female, and 4 (67%) donors were blood-related to the recipient. The median age for donors and recipients was 57.5 and 51.5 years, respectively. The stones, primarily located in the lower calyx, had a median size of 6 mm. The median cold ischemia time during surgery was 41.6 min, and ex vivo f-URS ensured complete stone removal in all cases. After a median follow-up of 120 months, the remaining grafts were functioning well, and no urinary stone recurrence was observed in either the recipients or living donors. The findings suggest that bench f-URS is a safe approach for managing urinary stones in kidney grafts, providing good functional outcomes without stone recurrence in selected cases.

Keywords: Bench surgery; Flexible ureterorenoscopy (f-URS); Kidney transplant; Living donor; Urolithiasis.

Fig. 1

After the cold perfusion in the bench surgery, with the kidney graft immersed in ice slush the procedure starts with the introduction of a re-usable flexible ureteroscope with a constant irrigation at 40 cm H₂O and a manual syringe allowing on-demand forced irrigation. The ureter and the kidney were fixed by the assistant and the introduction of the scope was gently assessed through the ureter reaching the renal pelvis