Urolithiasis in renal transplant donors and recipients

Abstract

Allograft nephrolithiasis is an uncommon complication following renal transplantation. Stones may develop de novo in the graft or may be present in the grafted kidney at the time of transplant. A donor with history of stone disease is suitable for donation if he does not have any risk factors that predict recurrent stone formation. If a potential donor has a stone, he is accepted for donation if stone is less than 1.5 cm and if this can be removed during transplantation. Ex vivo removal of graft stone is a viable option, but this adds to the cold ischemia time and has the potential for injuring the pelvicalyceal system. For stones less than 0.5 cm, a watchful waiting strategy is optimal unless there is obstruction. For 0.5’1.5-cm stones, shock wave lithotripsy is feasible, but a percutaneous nephrostomy or double-J stent insertion may be necessary if the outflow tract is obstructed. Percutaneous nephrolithotomy and antegrade ureteroscopy are the management of choice for bigger stone burden with special care to avoid bleeding and bowel injury. Open surgery is restricted to select cases. A multidisciplinary approach is tailored according to stone and graft conditions.