Introduction: Transplantation of the graft in the presence of a stone in the graft kidney is still controversial. In the literature, there are studies indicating that a stone in the graft kidney may cause urinary tract infection in the recipient and may cause ureteral obstruction leading to graft loss. On the other hand, recent studies have shown that single and asymptomatic stones detected incidentally do not pose any long-term risk for the donor and recipient. We investigated the long-term outcomes of donor gifted nephrolithiasis performed in our center on recipients.
Methods: Our team, which performed the first kidney transplant in Turkey and the region in 1978, has performed 3518 kidney transplants to date. Between February 2012 and August 2023, we retrospectively analyzed the kidney transplants performed in our center for those who had stones in the graft kidney. Radiological evaluation of all donors was performed with high sensitive multisection computed tomography in the preoperative period. Preoperative parathormone and calcium levels of donors, preoperative parathormone and calcium levels of recipients, size and number of stones in the graft kidney, perioperative complications, postoperative serum creatine levels and postoperative ultrasonographic findings were recorded and analyzed.
Results: Donor gifted nephrolithiasis was detected in 18 kidney transplantations performed between February 2012 and August 2023. All of these grafts were obtained from living donors. All donors were asymptomatic and had no history of stone-related disease. All donors were related to the recipients.  The mean preoperative parathormone level was 46 (14-70) ng/L and the mean calcium level was 9.4 (8.9-10.2) mg/dl. Thirteen (78%) of the recipients were female and the mean age was 43 (25-67) years. The mean preoperative parathormone level was 625 (97-1357) ng/L and the mean calcium level was 9.3 (7.4-10.7) mg/dl. All grafts had one stone and the mean stone size was 4.1 mm (1-10 mm). No intraoperative stone-related complications were observed in any patient. Urinary tract infection developed in 3 patients in the early period and was treated with antibiotic therapy. Creatinine values of the recipients were 3.02 mg/dl on postoperative day 1, 1.5 mg/dl on postoperative day 7, 1.33 mg/dl on postoperative month 1, 1.26 mg/dl on postoperative month 3 and 1.11 mg/dl on postoperative year 1. Ultrasonography performed 6 months after renal transplantation showed no stones in 17 recipients. In 1 patient, the stone persisted in the same size.
Conclusion: Transplantation of grafts with single and asymptomatic stones is not contraindicated for the recipient in the long term.