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  • Title: Caliceal fistula formation following renal transplantation: management with partial nephrectomy and ureteral replacement.
    Author: Gutiérrez-Calzada JL, Ramos-Titos J, González-Bonilla JA, Garcia-Vaquero AS, Martin-Morales A, Burgos-Rodríguez R.
    Journal: J Urol; 1995 Mar; 153(3 Pt 1):612-4. PubMed ID: 7861495.
    Abstract:
    Six patients in this series of 543 renal transplants (1.10%) suffered a post-transplant renal segmental infarct of the donor kidney because of occlusion of an accessory renal artery. Five grafted kidneys had multiple renal arteries. Patients presented with symptoms of a caliceal fistula and were treated by partial (25 to 40%) transplant nephrectomy, followed by closure and tissue coverage with either parietal peritoneum (4 patients) or lyophilized human dura mater sealed with fibrin (2). In 2 cases the renal ischemia and necrosis involved the ureter, and a pyelo-pyelostomy was performed. One patient died of cardiorespiratory complications immediately postoperatively. Five years postoperatively all kidneys functioned well without recurrence of fistula and 5 patients returned to a normal life-style. The combination of radical excision and tissue closure, plus ureteral substitution when needed was an effective treatment that prevented loss of the graft.
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