Trasplante renal en pacientes con enterocistoplastia

Resumen

Objetivos

Evaluar la evolución y resultados del trasplante renal de donante cadáver en pacientes con ampliaciones vesicales realizadas por alteración del tracto urinario inferior (TUI).

Pacientes y métodos

Entre 1980 y 2001 hemos realizado 4 trasplantes renales en pacientes con fibrosis vesical restrictiva secundaria a tuberculosis (3 hombres y 1 mujer). Previamente se realizó ampliación vesical intestinal: 3 ileocecocistoplastias y 1 ileocistoplastia.

Resultados

Tras 27 y 74 meses desde el trasplante renal 2 pacientes conservan buena función renal. Un paciente perdió el injerto por rechazo crónico a los 98 meses y el restante falleció a los 36 meses por sepsis de origen intestinal, conservando el injerto funcionante. Tres casos tuvieron complicaciones post-quirúrgicas que precisaron de tratamiento instrumental. Ningún paciente presentó incontinencia urinaria.

Conclusiones

La enterocistoplastia es un procedimiento seguro y eficaz para pacientes con alteración del TUI y que precisan de trasplante renal.

Abstract

Objectives

To asses the impact of augmentation enterocystoplasty on the success of cadaveric renal transplantation in patients with dysfunctional bladders.

Patients and methods

Between 1980 and 2001, 3 men and a woman with severe dysfunctional lower urinary tract underwent a total of 4 cadaveric renal transplantations. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in all cases. In 3 patients were performed an enterocystoplasty with ileocecal segment and one with ileon.

Results

The overall allograft survival was 58.7 months. Two patients have functioning grafts 27 and 74 months after transplant, 1 has died due to an intestinal disease and other had crohnic rejection after follow-up of 98 months. Technical complications occurred in 3 patients. All patients remain continent without catheterization after the transplantation.

Conclusions

Enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small non compliant bladder.