Major urologic complications occurred in 9% of 173 kidney transplants. In all but 1 transplant ureteroneocystostomy was the method of reconstructing the urinary tract. Eleven of the 15 patients with urologic complications had satisfactory results and retained functioning allografts, 3 required allograft nephrectomy because of uncontrollable sepsis and lived, and 1 patient died as a result of associated septicemia when the graft was not removed. Two thirds of the patients with infected urinary drainage and all of the patients with non infected urinary drainage had satisfactory repairs and retained functioning grafts. Urologic complications may be caused by technical errors in the donor nephrectomy or in the renal transplant procedure. The transplant should be sacrificed when a urologic complication is associated with uncontrolled sepsis but successful urinary tract repair can occur despite infected urinary drainage.
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