# Current clinical standards for renal transplantation: a survey among urological and surgical transplantation centers in Germany

## TL;DR

This survey compares clinical practices in kidney transplantation among urological and surgical centers in Germany, finding mostly similar standards with minor differences in techniques and postoperative care.

## Contribution

The study provides a detailed comparison of perioperative standards in kidney transplantation across urological and surgical centers in Germany.

## Key findings

- Most kidney transplants in Germany are performed extraperitoneally via hockey-stick incision.
- There are minor differences in postoperative management, such as catheterization duration and discharge timing.
- The Lich-Gregoir technique is commonly used for ureteral implantation in both urological and surgical programs.

## Abstract

Kidney transplants in Germany are either performed by surgical, urological or interdisciplinary teams. Hence, perioperative details might differ in relevant ways. The aim of our survey was to record and compare the respective perioperative standards.

A structured 50-item questionnaire was sent via email to all certified German kidney transplant centers (n = 38). Anonymized data collection was performed with www.surveymonkey.com from November 2023 – May 2024.

Complete responses were obtained from 34/38 centers (response rate 89.5%); 13 were urological-led and 21 surgical-led programs. In most cases (76% urological vs. 90% surgical, n = 10 and 19), transplantation is performed extraperitoneally via hockey-stick incision. A peritoneal fenestration for lymphocele prophylaxis is not performed routinely (69% vs. 86%, n = 9 and 18). Vascular anastomoses are primarily frequently sutured with 5 − 0 or 6 − 0 prolene, and the ureteral anastomosis with 4 − 0, 5 − 0 or 6 − 0 PDS suture. The Lich-Gregoir technique is most commonly used for ureteral implantation (84% in urology vs. 76% in surgery, p = 0,55). There are only small differences in postoperative management between urological and surgical programs, e.g. regarding the duration of catheterization (7–10 days vs. < 7 days; p = 0.008) or the time of discharge (10–14 days vs. 6–8 days; p = 0,05).

The majority of kidney transplants in Germany is performed according to similar standards. There are minor differences in the specialists approach, e.g. in the choice of suture material. Certain practices, such as peritoneal fenestration for lymphocele prophylaxis, warrant further scientific evaluation.

The online version contains supplementary material available at 10.1007/s00345-025-06094-2.