V01-07: Ex-vivo ureteroscopy treatment of deceased donor kidney calculi on perfusion machine
The incidence of renal lithiasis found in brain-dead donors and by cardiac-arrest is rare. Management of urolothiasis on these donors is not codified. Should they be treated before or after transplantation? A few teams proposed ex-vivo rigid or flexible ureteroscopy treatment before transplantation. This video is focused on two cases of kidney stones treatment by flexible ureteroscopy performed on a perfusion machine. We have developed an ex-vivo flexible ureteroscopy technique on the graft that has been put on an hypothermic perfusion machine.
Two patients received a transplant. According to French kidney transplantation guidelines, the grafts were placed on an infusion machine and maintained at a temperature of 4 degrees Celsius.Both kidneys had lithiasis discovered on pre-organ procurement imaging. An ex-vivo flexible ureteroscopy was performed on transplant held on Lifeport* perfusion machine.
A 4mm stone localized in the upper caliciel of the first kidney was treated by laser fragmentation and then basket extraction. A 7mm stone was observed on the CT-scan, which turned out to be a cluster of micro-lithiasis. Largest fragments were recovered with a extraction basket. The rest was fragmented into dust. The cold ischemia time was 31h30 and 10h49. Concerning the first patient, after 28-monthes follow-up, there was neither lithiasis recurrence, nor urological complication. The second patient developed a type-B lymphoma, for which a transplantectomy was performed at 8 months. Nadirs of creatinine levels were 90 µmol/L and 154 µmol/L respectively. No lithisiasic events occur during monitoring of the contralateral kidneys and their creatinine nadirs were 177 µmol/L and 101 µmol/L respectively.
When the procedure is feasible and does not prolong cold-ischemia time, ex-vivo flexible ureterorenoscopy on machine-perfused kidneys appears to be a good alternative to treat graft lithiasis.