Prophylactic Ureteric Stents in Renal Transplant Recipients: A Multicenter Randomized Controlled Trial of Early Versus Late Removal

Abstract

Prophylactic ureteric stenting in renal transplantation reduces major urological complications; however, morbidity is related to the indwelling duration of a stent. We aimed to determine the optimal duration for stents in this clinical setting. Patients (aged 2-75 years) from six UK hospitals who were undergoing renal transplantation were recruited and randomly assigned to either early stent removal at 5 days (without cystoscopy) or late removal at 6 weeks after transplantation (with cystoscopy). The primary outcome was a composite of stent-related complications defined as pain, visible hematuria, migration, fragmentation, and urinary tract infections (UTIs) within 3 mo of transplantation. Between May 2010 and Nov 2013, we randomly assigned 227 participants, with 205 included in the final analysis of the primary outcome. Stent-related complications were significantly higher in the late versus early stent removal groups (36 of 126 [28.6%] vs. 6 of 79 [7.6%]; p < 0.001). The majority of stent complications consisted of UTIs, with an incidence of 31 of 126 (24.6%) in the late group compared with 6 of 79 (7.6%) in the early group (p = 0.004). We found early stent removal on day 5 significantly reduced stent-related complications and improved quality of life in the first 3 mo after transplantation (ISRCTN09184595).

No evidence for the need of a routine renal transplant ultrasound after elective transplant ureteric stent removal—A retrospective cohort study

“…A recent meta‐analysis on the current practice of ureteric stent removal found that removal within 3 weeks after transplantation is associated with a significant reduction in UTIs without risking an increased incidence of MUCs 17 . Our multi‐centre randomized controlled trial on the optimal duration for stents in pediatric and adult renal transplantation (TrUST trial—ISRCTN09184595) found that removing stents early (at 5 days) rather than later (at 6 weeks) significantly reduced the rate of stent‐related complications 26 …”

How to stent the ureter after kidney transplantation in children?—A comparison of two methods of urinary drainage

“…In the late removal group, stent‐related complications, especially UTIs, were significantly more frequent. These indicate that early removal reduces significantly stent‐related complications . In several studies, stenting is identified as an independent risk factor of another infectious complication, that is BK virus nephropathy .…”

“…These indicate that early removal reduces significantly stent-related complications. 27 In several studies, stenting is identified as an independent risk factor of another infectious complication, that is BK virus nephropathy. 28,29 In all studies reporting this association, stenting was performed with an indwelling (JJ) catheter.…”

Review of stentless, tubeless, apposed renal (STAR) transplant wound management programme

“…A recent randomised controlled trial confirmed that early stent removal on Day 5 significantly reduced stent-related complications and improved quality of life in the first three months after transplantation. (8) A Cochrane review by Wilson et al, (7) including 1,154 patients, found that patients who had ureteric stents developed more complications of haematuria, irritative symptoms and stent-related pain. Significantly, two grafts were lost as a result of stent-related infectious complications and pooled results also indicated a general increased risk of urinary tract infection with the use of stents.…”