Transplantation of a Kidney with Donor-Derived Ureteritis Cystica

Introduction: Ureteritis cystica (UC) is a rare, benign condition characterized by formation of multiple small cysts within the ureteral lining, typically arising from chronic irritation or inflammation. Here we describe the first documented case of kidney transplantation involving a donor ureter affected by UC. Case Description: A 62-year-old Hispanic male with polycystic kidney disease underwent a kidney transplantation from a 60-year-old white male donor (KDPI 80%) in September 2024. Intraoperatively, multiple pearly cystic nodules were found at the distal donor ureter. Histology evaluation confirmed a UC (Figure 1). Subsequently, the patient developed hydroureteronephrosis from a distal ureteral stricture, with worsening kidney function relieved by percutaneous nephrostomy. Though initially attributed to recurrence of UC; however, antegrade nephrostogram revealed no cystic features. Follow-up imaging showed ureteric stenosis and enhancing tissue at the renal transplant hilum, raising concern for post-transplant lymphoproliferative disorder (PTLD). The patient underwent ureteral resection with reimplantation into the bladder. Histological analysis of the resected ureter revelaed no evidence of cystic changes or PTLD. At 6 months, the patient remains with stable allograft function. Discussion: UC was incidentally found in the donor ureter and managed with back-table excision, allowing first successful documented kidney transplantation involving this condition. Although the patient developed ureteral stenosis —a common post-transplant complication— this anecdotal evidence in a donor organ may raise concerns; however, this case illustrates that such findings do not necessarily preclude favorable outcomes.Figure 1. A. Submucosal epithelial-lined cysts on frozen section. B. Cyst lined by attenuated urothelium.