Abstract: SA-PO1043
Transplant of Kidney with Hydroureteronephrosis Following Trauma: A Case Supporting Marginal Organ Use
Session Information
- Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Chapa, Isabel, The University of Texas Medical Branch John Sealy School of Medicine, Galveston, Texas, United States
- Iyer, Sudhanvan, The University of Texas Medical Branch John Sealy School of Medicine, Galveston, Texas, United States
- Wang, Joshua, The University of Texas Medical Branch John Sealy School of Medicine, Galveston, Texas, United States
- Nguyen, Philong, The University of Texas Medical Branch John Sealy School of Medicine, Galveston, Texas, United States
- Logan, Cara, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Sonstein, Joseph, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Rastellini, Cristiana, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Cicalese, Luca, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Introduction
In 2024, 86% of transplant list individuals awaited a kidney, yet over 5,000 died waiting while >3,500 potentially usable kidneys were discarded. One reason for rejection is hydroureteronephrosis (HUN), a common contraindication for transplant[1,2]. However, its reversibility and impact on long-term graft function remain unclear. We present a successful kidney transplant case from a donor with traumatic HUN.
Case Description
A 54 y/o woman with ESRD received DDKT from 27 y/o male with low KDPI and history of traumatic left HUN and capsular laceration. The dilated ureter and bladder were anastomosed with a stent, with excellent initial function. However, following stent removal ureteral stenosis and progressive HUN developed secondary to edema and ureteral collapse. After unsuccessful percutaneous nephrostomy and prolonged ureteral stenting, calicovesicotomy was performed. Renal function returned to baseline, follow-up confirmed resolution of HUN, and nephrostomy was removed.
Discussion
Kidneys with HUN can be grafted with excellent long-term function, yet direct ureteral anastomosis may lead to post-transplant obstruction and UTIs. We thus suggest direct pyelovesical or calicovesical anastomosis to avoid complications and reoperations. This success underscores the life-saving potential of reevaluating marginal kidneys for transplant.
A. Donor kidney presenting with hydroureteronephrosis. Anterior view.
B. Cytouretheroscopy 3 months post-transplant with 17fr flexible scope, showing persistent edema.