A case of living renal transplantation 34 years after whole pelvic radiation therapy for an ovarian tumor

Abstract

[Background] Radiation therapy is known to cause radiation arteritis or ureteral anastomotic failure due to adhesion or impaired blood flow. We performed a living renal transplantation for a recipient with a history of whole pelvic radiation therapy for an ovarian tumor 34 years prior to the surgery. [Case presentation] The recipient and donor passed the preoperative diagnosis successfully. Abdominal CT of the recipient showed no signs of calcification or strictures or vascular endothelial hyperplasia of the internal iliac artery or external iliac vein. The surgery was performed in 7 hours without vascular anastomotic problems. The first urine was noted 12 minutes after vascular anastomosis. The surgery was considered to have proceeded without complications. However, on post-operative day 11, ureteral anastomotic leak occurred. The recipientʼs serum examination showed creatinine elevation. Abdominal CT revealed liquid effusion around the transplanted kidney. An effusion drainage test showed a high level of creatinine elevation. The leak was successfully resolved without major complications by implanting a double J-stent in the transplanted ureter, a drainage tube around the transplanted kidney, and a urethral catheter. On post-operative day 30, the recipient was discharged from our hospital in a favorable condition. [Conclusion] Preoperative vascular assessment with CT was helpful in this case. Also, pressure reduction in the urinary tract may effectively prevent or cure ureteral anastomotic leak.