Kidney autotransplantation: long-term outcomes and complications. Experience in a tertiary hospital and literature review

Objective To analyze indications, surgical technique, complications and long-term outcomes of kidney autotransplantation (KAT) after 26-year experience at a single institution. Materials and methods A retrospective observational study of patients who underwent KAT at our institution (January 1990–December 2016) was carried out. Data collected included indications, surgical technique, complications (Clavien–Dindo), hospital stay and long-term outcomes. Literature review was performed through MEDLINE and ClinicalKey databases including “kidney,” “renal,” “autotransplantation” and “autograft.” Results Fifteen patients underwent a KAT, with a mean age of 41 years (range 34–59). Indications were vascular abnormalities in 8 cases and ureteral injury in 7. Nephrectomy was performed through laparoscopy in 2 cases (13.3%) and open in 13 (86.7%). Vascular grafts to reperfuse the kidney were used in 8 patients, and ureteral reimplantation was performed in 11 cases. Mean hospital stay was 9.1 days (range 3–20). Seven patients (46.7%) developed postoperative complications: 6 minor (Clavien I–II) and 1 major (Clavien III). After a mean follow-up of 73.1 months (range 7–312), 80% of the patients have a functioning graft. Most common indication reported in the literature is ureteral stricture, especially in the most recent years. Graft survival is variable, and complications are frequent, but usually minor. Conclusions KAT is an effective treatment for complex ureteral lesions and kidney vascular abnormalities, with good results in the long term. Surgical complications are frequent, but usually minor. As a challenging surgery, it should be performed by experienced kidney transplant surgeons. Complex and proximal ureteral injuries are nowadays the main indication of this procedure.