Renal Transplantation Clinical Practice Guidelines (2018)

European Association of Urology

Reviewed and summarized by Medscape editors

August 09, 2018

The clinical practice guidelines on renal transplantation management were released on July 19, 2018, by the EAU.[1]

Check the intima of the donor and recipient arteries prior to commencing the arterial anastomosis to ensure that there is no intimal rupture/flap. If the latter is found, it must be repaired prior to/as part of the arterial anastomosis.

Preoperatively plan the surgical approach in third or further transplants to ensure that appropriate arterial inflow and venous outflow exists with adequate space to implant the new kidney.

Use the external or common iliac arteries for an end-to-side arterial anastomosis to donor renal artery.

Use an end-to-end anastomosis to the internal iliac artery as an alternative to the external or common iliac arteries.

Perform color Doppler ultrasound in cases of suspected graft arterial or venous thrombosis.

Perform color Doppler ultrasound to diagnose an arterial stenosis; in the event of indeterminate results on ultrasound, consider a magnetic resonance or computed tomography angiogram.

Perform percutaneous drainage placement as the first treatment for large and symptomatic lymphocele.

Manage urine leak by JJ stent and bladder catheter and/or percutaneous nephrostomy tube. Perform surgical repair in cases of failure of conservative management.

Manage ureteral strictures <3 cm in length either with surgical reconstruction or endoscopically (percutaneous balloon dilation or antegrade flexible ureteroscopy and holmium lazer incision). Treat late stricture recurrence and/or strictures >3 cm in length with surgical reconstruction in appropriate recipients.

Perform shockwave lithotripsy or antegrade/retrograde ureteroscopy for stones measuring <15 mm.

Provide lifelong regular posttransplant follow-up by an experienced and trained RT specialist at least every 6–12 mo.

Regularly monitor (approximately every 4–8 wk) serum creatinine, estimated glomerular filtration rate, blood pressure, urinary protein excretion, immunosuppression, and complications after RT. Changes in these parameters over time should trigger further diagnostic workup, including renal biopsy, a search for infectious causes, and anti-HLA antibodies.

Perform an ultrasound of the graft in cases of graft dysfunction in order to rule out obstruction and renal artery stenosis.

In patients with interstitial fibrosis and tubular atrophy undergoing CNI therapy and/or with histologic signs suggestive of CNI toxicity (eg, arteriolar hyalinosis, striped fibrosis), consider CNI reduction or withdrawal.

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