Korean J Transplant.  2021 Mar;35(1):41-47. 10.4285/kjt.20.0050.

The impact of prophylactic ureteral stenting during kidney transplantation on postoperative surgical outcomes

• Park J
• Lee SY
• Lee HS
• Shin SK
• Kim TH

• KMID: 2514407
• DOI: http://doi.org/10.4285/kjt.20.0050

Abstract

Background
The aim of this study was to evaluate the safety and feasibility of prophylactic ureteric stenting during kidney transplantation (KT).
Methods
The authors retrospectively reviewed patients who underwent KT between June 2016 and June 2019. The prophylactic ureteral stenting group (double-J [DJ]) and no-stent group (no-DJ) were compared with respect to the clinical data and surgical outcomes.
Results
A total of 42 patients underwent KT; 17 patients were classified into the DJ group and 25 patients into the no-DJ group. Antithymocyte globulin induction and donor-specific antibody positivity were significantly higher in the DJ group. There were no significant differences between the groups in terms of symptomatic urinary tract infection (UTI). The time to postoperative UTI was significantly shorter in the DJ group than in the no-DJ group (33.5±7.8 vs. 105.3±71.6 days, P=0.013). The development of postoperative BK viremia was significantly higher in the no-DJ group (0.0% vs. 16.0%, P=0.035). Urologic complications were significantly higher in the no-DJ group (0.0% vs. 16.0%, P=0.035). In the no-DJ group, urologic complications occurred in four patients: ureteroneocystostomy stenosis in three patients and ureteroneocystostomy leakage in one patient. Percutaneous ureteral interventions were performed for all patients using percutaneous nephrostomy and reno-uretero-vesical stenting. However, there were no postoperative urologic complications in the DJ group.
Conclusions
Prophylactic ureteric stenting during KT may be safe and feasible without significantly increasing the incidence of UTI and BK viremia. Additionally, prophylactic ureteric stenting may reduce urologic complications after KT.

Keyword

Ureter; Stents; Postoperative complication; Kidney transplantation; Urinary tract infection

Reference

1. Kumar A, Verma BS, Srivastava A, Bhandari M, Gupta A, Sharma R. 2000; Evaluation of the urological complications of living related renal transplantation at a single center during the last 10 years: impact of the Double-J stent. J Urol. 164(3 Pt 1):657–60. DOI: 10.1016/S0022-5347(05)67275-8.

2. Butterworth PC, Horsburgh T, Veitch PS, Bell PR, Nicholson ML. 1997; Urological complications in renal transplantation: impact of a change of technique. Br J Urol. 79:499–502. DOI: 10.1046/j.1464-410X.1997.00117.x. PMID: 9126075.

3. Mangus RS, Haag BW. 2004; Stented versus nonstented extravesical ureteroneocystostomy in renal transplantation: a metaanalysis. Am J Transplant. 4:1889–96. DOI: 10.1111/j.1600-6143.2004.00595.x. PMID: 15476491.

4. Tavakoli A, Surange RS, Pearson RC, Parrott NR, Augustine T, Riad HN. 2007; Impact of stents on urological complications and health care expenditure in renal transplant recipients: results of a prospective, randomized clinical trial. J Urol. 177:2260–4. DOI: 10.1016/j.juro.2007.01.152. PMID: 17509336.

5. Abrol N, Dean PG, Prieto M, Stegall MD, Taner T. 2018; Routine stenting of extravesical ureteroneocystostomy in kidney transplantation: a systematic review and meta-analysis. Transplant Proc. 50:3397–404. DOI: 10.1016/j.transproceed.2018.06.041. PMID: 30577212.

6. Kumar A, Kumar R, Bhandari M. 1998; Significance of routine JJ stenting in living related renal transplantation: a prospective randomised study. Transplant Proc. 30:2995–7. DOI: 10.1016/S0041-1345(98)00902-6. PMID: 9838320.

7. Junjie M, Jian X, Lixin Y, Xiwen B. 1998; Urological complications and effects of double-J catheter in ureterovesical anastomosis after cadaveric kidney transplantation. Transplant Proc. 30:3013–4. DOI: 10.1016/S0041-1345(98)00909-9. PMID: 9838327.

8. Wilson CH, Bhatti AA, Rix DA, Manas DM. 2005; Routine intraoperative stenting for renal transplant recipients. Transplantation. 80:877–82. DOI: 10.1097/01.tp.0000181197.21706.fa. PMID: 16249733.

9. Fayek SA, Keenan J, Haririan A, Cooper M, Barth RN, Schweitzer E, et al. 2012; Ureteral stents are associated with reduced risk of ureteral complications after kidney transplantation: a large single center experience. Transplantation. 93:304–8. DOI: 10.1097/TP.0b013e31823ec081. PMID: 22179401.

10. Wingate JT, Brandenberger J, Weiss A, Scovel LG, Kuhr CS. 2017; Ureteral stent duration and the risk of BK polyomavirus viremia or bacteriuria after kidney transplantation. Transpl Infect Dis. 19:e12644. DOI: 10.1111/tid.12644. PMID: 27910187.

11. Thomas A, Dropulic LK, Rahman MH, Geetha D. 2007; Ureteral stents: a novel risk factor for polyomavirus nephropathy. Transplantation. 84:433–6. DOI: 10.1097/01.tp.0000269616.21698.10. PMID: 17700172.

12. Kayler L, Zendejas I, Schain D, Magliocca J. 2013; Ureteral stent placement and BK viremia in kidney transplant recipients. Transpl Infect Dis. 15:202–7. DOI: 10.1111/tid.12051. PMID: 23331475.

13. Hashim F, Rehman S, Gregg JA, Dharnidharka VR. 2014; Ureteral stent placement increases the risk for developing BK viremia after kidney transplantation. J Transplant. 2014:459747. DOI: 10.1155/2014/459747. PMID: 25295178. PMCID: PMC4177822.

14. Goldman JD, Julian K. 2019; Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 33:e13507. DOI: 10.1111/ctr.13507. PMID: 30793386.

15. Haas M, Loupy A, Lefaucheur C, Roufosse C, Glotz D, Seron D, et al. 2018; The Banff 2017 Kidney Meeting Report: revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 18:293–307. DOI: 10.1111/ajt.14625. PMID: 29243394. PMCID: PMC5817248.

16. Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, et al. 2006; Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 20:401–9. DOI: 10.1111/j.1399-0012.2006.00519.x. PMID: 16842513.

17. Patel P, Rebollo-Mesa I, Ryan E, Sinha MD, Marks SD, Banga N, et al. 2017; Prophylactic ureteric stents in renal transplant recipients: a multicenter randomized controlled trial of early versus late removal. Am J Transplant. 17:2129–38. DOI: 10.1111/ajt.14223. PMID: 28188678.

18. Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, et al. 2017; Optimal timing for removal of the double-J stent after kidney transplantation. Transplant Proc. 49:523–7. DOI: 10.1016/j.transproceed.2017.01.008. PMID: 28340826.

19. Mannu GS, Bettencourt-Silva JH, Gilbert J. 2014; The ideal timing of ureteric stent removal in transplantation patients. Transpl Int. 27:e96–7. DOI: 10.1111/tri.12363. PMID: 24861523.

20. Visser IJ, van der Staaij JP, Muthusamy A, Willicombe M, Lafranca JA, Dor FJ. 2019; Timing of ureteric stent removal and occurrence of urological complications after kidney transplantation: a systematic review and meta-analysis. J Clin Med. 8:689. DOI: 10.3390/jcm8050689. PMID: 31100847. PMCID: PMC6572676.

21. Atencio IA, Shadan FF, Zhou XJ, Vaziri ND, Villarreal LP. 1993; Adult mouse kidneys become permissive to acute polyomavirus infection and reactivate persistent infections in response to cellular damage and regeneration. J Virol. 67:1424–32. DOI: 10.1128/JVI.67.3.1424-1432.1993. PMID: 8382304. PMCID: PMC237512.

22. Atencio IA, Villarreal LP. 1994; Polyomavirus replicates in differentiating but not in proliferating tubules of adult mouse polycystic kidneys. Virology. 201:26–35. DOI: 10.1006/viro.1994.1262. PMID: 8178487.

23. Cormio L, Talja M, Koivusalo A, Mäkisalo H, Wolff H, Ruutu M. 1995; Biocompatibility of various indwelling double-J stents. J Urol. 153:494–6. DOI: 10.1097/00005392-199502000-00069. PMID: 7815632.

24. Lumiaho J, Heino A, Pietiläinen T, Ala-Opas M, Talja M, Välimaa T, et al. 2000; The morphological, in situ effects of a self-reinforced bioabsorbable polylactide (SR-PLA 96) ureteric stent: an experimental study. J Urol. 164:1360–3. DOI: 10.1016/S0022-5347(05)67199-6.

25. Karam G, Maillet F, Parant S, Soulillou JP, Giral-Classe M. 2004; Ureteral necrosis after kidney transplantation: risk factors and impact on graft and patient survival. Transplantation. 78:725–9. DOI: 10.1097/01.TP.0000131953.13414.99. PMID: 15371676.