N. M. Bath1, T. Al-Qaoud1, H. W. Sollinger1, R. R. Redfield1 1University Of Wisconsin,Transplant,Madison, WI, USA
Introduction: Loin Pain Hematuria Syndrome (LPHS) is a rare clinical entity in which patients typically present with severe loin pain. This pain is often debilitating to the point that patients require narcotics for pain control and are often unable to continue employment. Renal autotransplantation is a potential treatment although results are varied. This highlights the importance of patient selection. In order to improve patient selection, we developed the UW-LPHS Test. Here we describe our initial results.
Methods: A retrospective chart review was performed which identified 15 patients with LPHS who underwent renal autotransplantation at a single institution between January 2017 to May 2018. In order to identify patients with LPHS who would likely benefit from autotransplantation, patients underwent bupivacaine injection into the ureter via cystoscopy, known as the UW-LPHS Test. Patients who report pain relief following the UW-LPHS Test are then deemed to benefit from renal autotransplantation. Pre-operative length of pain, pain medications taken pre-operatively, resolution of pain following the UW-LPHS Test, post-operative complications, and return to normal lifestyle were among data points collected.
Results: All patients had previously undergone extensive work-up to determine the etiology of their pain. Nutcracker Syndrome (NCS) was identified as the cause of LPHS in 60% of patients (n=9) with 55.5% of NCS patients (n=5) having undergone previous operative interventions which failed to resolve their pain. Of the 15 patients identified, 93.3% (n=14) underwent the UW-LPHS Test with near or complete resolution of their pain. Two patients not included in this cohort did not have pain relief following the UW-LPHS Test and were later diagnosed with interstitial cystitis. All patients report near complete or complete resolution of their pain post-operatively. 73.3% of patients (n=11) no longer require narcotics for pain control, and 26.7% of patients (n=4) are weaning their narcotic usage. 80% of patients (n=12) have returned to school or employment with 6.7% (n=1) planning to return in the coming months.
Conclusion: Renal autotransplantation for Loin Pain Hematuria Syndrome has been shown to reliably provide pain relief in this patient population; however, it is imperative to properly identify patients who will benefit from autotransplantation. The UW-LPHS Test appears to be an accurate predictor of successful outcomes following renal autotransplantation. Future studies are needed to further clarify the long-term outcomes in patients with LPHS who have undergone renal autotransplantation.