Outcomes of Kidney Transplant Recipients With Percutaneous Ureteral Interventions: A Single-Center Study

Abstract

BackgroundLong-term outcomes of kidney transplantation recipients with percutaneous ureteral management of transplant ureteral complications are not well characterized.MethodsElectronic records of 1753 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. One hundred thirty-one patients were identified to have undergone percutaneous ureteral management, with placement of percutaneous nephrostomy tube or additional intervention (nephroureteral stenting and/or balloon dilation). Indications for intervention included transplant ureteral stricture or ureteral leak. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes.ResultsKaplan- Meier graft survival (P = 0.04) was lower in patients with percutaneous ureteral intervention for transplant ureteral complication. Graft survival at 1, 5, and 10 years was 94.3% 78.3%, and 59.1% for no intervention and 97.2%, 72.1%, and 36.2% for intervention cohort. Patient survival (P = 0.69) was similar between cohorts. Multivariate analysis demonstrated no association with graft failure (hazard ratio, 1.21; 95% confidence interval, 0.67-2.19; P = 0.53) or patient death (hazard ratio, 0.56; 95% confidence interval, 0.22-1.41; P = 0.22) in intervention group. The major cause of graft failure was infection for percutaneous ureteral intervention group (20.4%) and chronic rejection for those without intervention (17.3%).ConclusionsKidney transplant recipients with percutaneous ureteral interventions for ureteral complications do not have a significant difference in graft and patient survival outcomes. Therefore, aggressive nonoperative management can be confidently pursued in the appropriate clinical setting.

Percutaneous Nephrostomy in the Treatment of Hydronephrosis in Renal Transplant Patients – Case Report

“…The permanent percutaneous nephrostomy tube was placed as the only possible solution for the preservation of graft's function. Srinivasan D. et al analyzed 58 renal transplant patients with ureteral stricture, 8 (14.2%) required surgical revision and 2 (3.5%) were with permanent PCN, as it was in our case 1 [3]. Many recent studies highlight the concept of prolonged ureteral stenting (more than 12 months) in order to provide sufficient dilatation of ureteral stenosis and to avoid open surgery [4,12,13].…”

“…The recent analysis of 389 transplant patients with percutaneous nephrostomy showed a major complication rate of 9.6%, with one dead patient from urosepsis, one colonic injury, three major renal bleeding with need of urgent surgical treatment, from which one patient lost the kidney allograft [14]. In the study of Srinivasan D. et al only 2 out of 58 patients (3.5%) were treated with permanent PCN after exhausting of all other procedures with stabile graft function and no major complications during the follow-up of 34 months [3]. Patel et al also reported a high technical and clinical success rate of percutaneous nephrostomy, with a 30-day major complication rate of 1.4%, an overall complication rate of 6.8% and no graft losses [15].…”

“…[1,2]. Open surgical techniques were traditionally used for the correction of ureteral obstruction, but they were associated with higher morbidity and pro-longed stay in the hospital [3]. Interventional radiology provided minimally invasive percutaneous techniques as an alternative to surgery with a comparable rate of success and fewer complications [1].…”

Solid Organ Transplantation in Older Adults. Infectious and Other Age-Related Considerations

“…hemodialysis versus peritoneal dialysis, hemodialysis via permcath, fistula or graft, history of prior peritonitis etc. Other factors are living donor availability, delayed graft function[ 63 ], use of ureteral stents[ 64 ], need for percutaneous nephrostomy tubes[ 65 ] etc.…”

Ureteral strictures post-kidney transplantation: Trends, impact on patient outcomes, and clinical management

“…6 Some reported risk factors for ureteral strictures include older donor age (> 65 years), recipient male sex, kidneys with more than 2 arteries, delayed graft function, prolonged cold ischemia, fluid collections around the ureter, and BK virus infections. 11,[16][17][21][22] There is disagreement regarding the role of surgical technique as a risk factor, with some studies reporting a link, 6,[16][17]21 while others do not, 23 and this may be related to whether a refluxing or non-refluxing anastomosis technique is utilized.…”