High ureteric injury following multiorgan recovery: successful kidney transplant with Boari flap ureterocystostomy reconstruction.

Abstract

Despite increased utilization of marginal organs, there is still a marked disparity between organ supply and demand for transplantation. To maximize resources, it is imperative that procured organs are in good condition. Surgical damage at organ recovery can happen and organs are sometimes discarded as a result. We describe a damaged recovered kidney with high ureteric transection that was successfully transplanted using a primary Boari flap ureterocystostomy. The donor kidney was procured form a deceased donor and sustained damage by transection of the ureter just distal to the pelvi-ureteric junction at organ recovery. The recipient had been on the transplant waiting list for eight years and not accepting this kidney would have seriously jeopardized her chance of future transplantation. Several centers rejected the donor kidney. We assessed the kidney and decided to proceed with transplantation. The kidney was successfully transplanted. A primary Boari flap was constructed and the transplant ureter implanted onto the bladder. The post-operative course was complicated by urine leak that settled down after management by nephrostomy insertion and bladder catheterization. The patient made a good recovery and remained well at six monthly follow up with a serum creatinine of 1.7 mg/dl. Primary Boari flap ureterocystostomy is a viable option when the transplant surgeon is faced with a high ureteric injury in the procured kidney. Since most patients wait years for a suitable graft and some may never find an adequate match, every effort should be made to effectively utilize the scarce available resources to the fullest.