Department of Surgery, University of California San Francisco, San Francisco, CA, United States.
School of Medicine, University of California San Francisco, San Francisco, CA, United States.
Urology. 2022 Aug;166:277-282. doi: 10.1016/j.urology.2022.04.032. Epub 2022 May 9.
To raise awareness that patients with proximal ureteral stricture who elect for nephrectomy can consider donating the kidney. We present a series of patients undergoing therapeutic living donor nephrectomy (TLDN), a scenario in which a patient undergoing nephrectomy for an underlying medical problem donates the kidney to a person with end-stage renal disease. This practice is underutilized, and only a single TLDN with proximal ureteral stricture has been previously described. We aim to help define the indications, risks, and benefits for patients.
This is a retrospective case series of seven therapeutic donors with proximal ureteral pathology and stone disease. Patient characteristics, donor work up, operative details, and donor and recipient outcome were collected.
All seven donors had proximal ureteral pathology, and six of the seven had nephrolithiasis or ureterolithiasis. After electing for nephrectomy, the mean time to TLDN was 57.9 days. No recipients experienced delayed graft function . Mean follow up was 40.1 months (range 8-131), and the most recent follow-up mean creatinine was 1.08 (mg/dL). Graft and recipient survival is 100%. No recipients developed recurrence of ureteral stricture or stones.
This is the first series demonstrating patients with proximal ureteral stricture, even with concomitant stone disease, may donate kidneys for transplantation. Recipient outcomes suggest this practice is safe, and appropriately selected patients that have already elected for nephrectomy should receive counseling about this opportunity. Importantly, patients who donate a kidney receive waiting list priority if they ever need a kidney transplant in the future.
提高认识，即选择肾切除术的近端输尿管狭窄患者可以考虑捐献肾脏。我们介绍了一系列接受治疗性活体供肾切除术（TLDN）的患者，在这种情况下，因潜在医学问题接受肾切除术的患者将肾脏捐献给终末期肾病患者。这种做法尚未得到充分利用，之前仅描述过一例近端输尿管狭窄的 TLDN。我们旨在帮助确定患者的适应症、风险和获益。
这是一项回顾性的 7 例近端输尿管病变和结石病治疗性供者的病例系列研究。收集了患者特征、供者检查、手术细节以及供者和受者的结果。
所有 7 例供者均存在近端输尿管病变，其中 6 例存在肾结石或输尿管结石。选择肾切除术后，TLDN 的平均时间为 57.9 天。没有受者发生延迟移植物功能。平均随访时间为 40.1 个月（8-131 个月），最近一次随访时的平均肌酐为 1.08（mg/dL）。移植物和受者的存活率为 100%。没有受者出现输尿管狭窄或结石复发。
这是第一个系列研究，表明即使存在合并结石病的近端输尿管狭窄患者，也可以捐献肾脏进行移植。受者的结果表明，这种做法是安全的，对于已经选择肾切除术的适当选择的患者，应就这一机会提供咨询。重要的是，如果患者将来需要进行肾移植，他们将获得候补名单的优先权。
