Routine use of ureteral stents may not be indicated after kidney transplant

D. A. Walczak, J. Oberholzer, P. Salehi, J. Thielke, H. Sankary, D. J. Walczak, G. Testa, B. Kaplan, Enrico Benedetti

Research output: Contribution to journalArticle

Abstract

Background: The use of ureteral stents after kidney transplantation (KTx) remains controversial. Methods: We reviewed urologic complications in 288 (83 cadaver {CAD}, 205 living related donor {LRD}), primary adult KTx performed at the University of Illinois at Chicago, between 1/02 and 1/06. The ureteral anastomosis consisted of a standardized ureteroneocystostomy according to the Lich technique. Double J (JJ), stents were placed across the anastomosis in 209 patients (Group A), and were not used in the remaining 79 patients (Group B). Stents were removed cystoscopically after 30 days. Immunosuppression consisted of Thymoglobulin induction and maintenance with Mycophenolate Mofetil (MMF) and Tacrolimus (TAC); steroids were discontinued on post-op day (POD) 6. The incidence of urinary tract infection treated on an out-patient basis (UTI/OPTX) or requiring hospitalization (UTI/HTX) during the first three months, hematuria, urinary leak and obstruction were recorded. A cost analysis was performed. Results: There was no difference in the incidence of UTI/HTX between the two groups. While not statistically significant, there was a trend toward a higher incidence of UTI/OPTX in the stent group (p=0.052). Furthermore, females in the stent group had a significantly higher incidence of UTI/OPTX (N=20,10%) (p=0.002), and a significantly higher rate of UTI/HTX (N=9, 4%) (p=0.031). There was no significant difference in the rate of gross hematuria in the two groups. While there were no urologic complications in the stent group, one patient (1.3%), in the unstented group developed urinary obstruction due to stricture at the pyelo-ureteral junction, successfully treated by percutaneous stenting. Patient cost related to the use of stents was $1800.00. Conclusion: Routine use of stents may not be indicated after KTX since this practice did not significantly affect the rate of urologic complications and is associated with an increased incidence of UTI in females as well as increased patient costs.

Original languageEnglish (US)
Pages (from-to)2-6
Number of pages5
JournalTransplantationsmedizin: Organ der Deutschen Transplantationsgesellschaft
Volume19
Issue number2
StatePublished - Oct 16 2007

Keywords

  • Kidney transplant
  • Post-kidney transplant
  • Stents
  • Ureteral stents

ASJC Scopus subject areas

  • Transplantation

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    Walczak, D. A., Oberholzer, J., Salehi, P., Thielke, J., Sankary, H., Walczak, D. J., Testa, G., Kaplan, B., & Benedetti, E. (2007). Routine use of ureteral stents may not be indicated after kidney transplant. Transplantationsmedizin: Organ der Deutschen Transplantationsgesellschaft, 19(2), 2-6.