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Editors,
We have carefully read the study published by Tisljar et al. on the effect of the pelvi-ureteric junction dysfunction (PUJ) on the outcome of kidney transplant from living donors [1]. There is an urgent need to expand the donors’ criteria to match the increasing demand for the organs available for transplantation [2]. Nevertheless, it is crucial to weigh the inevitable challenge of harming donors on one hand and saving lives of renal failure patients on the other hand [3]. George et al. reported PUJ complications occurred after about 6 years from kidney transplant [4]. While Doehn et al. reported ureteral complications occurred after 2129 days [5]. These periods were far more than the follow-up time reported by Tisljar et al [1]. Moreover, the retrospective nature of the aforementioned study limits the ability to produce any causal interpretation. We agreed with the authors that more prospective randomized long-term trials are needed to test their findings.
Finally, they did not assess the degree of PUJ or related vascular anatomic variations, which have pivotal implications in surgical approaches [6]. More severe degrees of PUJ might have different outcomes. The urge to minimize the gap between the number of candidates on the kidney transplant waitlist and the available leads to a tendency to relax the criteria of accepting more marginal donors and the increased utilization of surgically complex living donors. Nonetheless, more studies are needed to address the short- and long-term complications and outcomes for accepting candidates with PUJ dysfunction. A highly valid scoring system is urgently needed to expect the post-donation health hazards among those candidates, which assure the safety of those candidates.
References
Tisljar M, Ali H, Gledhill-Flynn C, Garreus M, Ponnusamy A, Ahmed A (2020) The outcome of kidney transplant from living donors with pelvi-ureteric junction dysfunction. Int Urol Nephrol 52:1863–1868
Saran R, Robinson B, Abbott KC, Agodoa LY, Albertus P, Ayanian J, Cope E (2017) US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 69(3):A7–A8
Matas AJ (2006) Transplantation using marginal living donors. Am J Kidney Dis 47(2):353–355
George K, Gopalakrishnan G, Al-Mamari SA, Viswaroop SB (2019) Late occurrence of pelvi-ureteric junction obstruction in renal allograft and live-related kidney donor. Saudi J Kidney Dis Transpl 30(6):1464
Doehn C, Böse N, Meyer AJ, Jocham D (2011) Results of secondary ureteral implantation after kidney transplantation. Int Urol Nephrol 43(3):669–674
Panthier F, Lareyre F, Audouin M, Raffort J (2018) Pelvi-ureteric junction obstruction related to crossing vessels: vascular anatomic variations and implication for surgical approaches. Int Urol Nephrol 50(3):385–394
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Nassar, M., Baraka, B., Osman, A. et al. The safety aspects of accepting living kidney donors with pelvi-ureteric junction dysfunction. Int Urol Nephrol 54, 461 (2022). https://doi.org/10.1007/s11255-021-02893-9
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DOI: https://doi.org/10.1007/s11255-021-02893-9