Introduction: With increasing demand for donor kidneys, physicians are seeking ways to increase the number of viable donor kidneys. Previously, the presence of kidney stones in a renal allograft was a relative contraindication for renal transplantation. It was our goal to demonstrate that ex-vivo ureteroscopy is a viable method of stone removal prior to transplantation.
Methods: Following removal and back table preparation of the donor kidney, a flexible ureteroscope is advanced into the ureter over a sensor wire. The kidney was maintained in an ice slush bath and cooled saline was used for irrigation. The stone was fragmented using a holmium laser and fragments were extracted using a stone basket. The kidney was then implanted into the recipient in the standard fashion. a
Results: After stone removal via ex-vivo ureteroscopy, the kidney allograft was successfully transplanted into the recipient. Following a delay in graft function, the patient was able to cease weekly hemodialysis and their creatinine nadir was 1.50 from 12. As of writing this report the patient is alive and the graft is functioning. There has been no stone recurrence in the 6 months post-op.
Conclusions: Ex-Vivo ureteroscopy is a safe and viable method for removal of renal stones from donor kidneys. This method can be used widely with existing tools and knowledge to increase the number of donor kidneys available for transplantation each year.
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