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

Abstract

Introduction: Ureteral strictures post-kidney transplantation (KT) can be a significant morbidity to the patient, often requiring surgical intervention and impacting graft function. We sought to investigate the incidence, clinical management, and outcomes of ureteral strictures among kidney transplant recipients (KTRs) at a large, multi-organ transplant center.
 Methods: We conducted a single-center cohort study looking at KTRs who had transplant surgery from January 1, 2005 to March 31, 2017 with at least one-year followup (n=1742). Any KTRs done outside of our center or simultaneous multiorgan transplants were excluded. The Kaplan-Meier product-limit method was used to determine the incidence of ureteral strictures. Risk factors for ureteric strictures and clinical outcomes among patients with vs. without ureteric strictures were analyzed using Cox proportional hazards models.
 Results: The incidence of ureteral strictures was 1.31 (95% confidence interval [CI] 0.85, 2.01) per 100 person-years or a cumulative incidence of 1.2%. We did not find any donor or recipient demographic variables that were independently associated with an increased risk of ureteral stricture development. A large proportion was managed successfully with radiologic intervention alone (47.6%). Ureteral strictures were associated with death-censored graft failure (hazard ratio [HR] 7.17, 95% CI 2.81, 18.30), total graft failure (HR 3.04, 95% CI 1.41, 6.59), and hospital re-admission (HR 2.52, 95% CI 1.58, 4.00).
 Conclusions: Although uncommon, ureteral strictures can significantly impact patient outcomes after KT. A better understanding of risk factors and clinical management will be important to ensure optimal graft outcomes.

Effect of ureteral stricture in transplant kidney and choice of treatment on long-term graft survival

“…With the continuous progress and innovation of donor evaluation, organ acquisition and repair, kidney transplantation, ureteral anastomosis and other technologies, the incidence of surgical complications related to kidney transplantation has decreased significantly [ 2 ]. However, ureteral stricture in transplant kidney is still one of the most common surgical complications after kidney transplantation at present, and the incidence rate is reported to be 1–8.3% in the literature, which is negatively correlated with long-term graft survival [ 3 – 5 ]. Improper treatment may damage the transplant kidney function and affect the long-term survival rate of the recipient and the transplant kidney [ 6 , 7 ].…”

Laparoscopic ureteral reconstruction in a kidney transplant: successful clinical cases

“…По данным различных источников, причинами развития стриктур мочеточника являются аномалии строения, такие как наличие нескольких питающих почечных артерий, избыточная протяженность, не-достаточное кровоснабжение мочеточника, фиброзирование окружающих тканей, возраст донора старше 65 лет, длительность холодовой ишемии, отсроченная функция трансплантата, формирование пузырно-мочеточникового анастомоза без стентирования [2,3]. Описаны отдельные случаи развития стриктур мочеточника трансплантата почки в сочетании с тубулоинтерстициальным нефритом, вызванным цитомегаловирусной инфекцией [4].…”