Urinary tract infection associated with ureteral stents in renal transplantation

OBJECTIVES: In the mid 1980s, ureteral stents were used in renal transplantation when ureteral injury had occurred. Subsequently, it was shown that routine ureteral stent placement at the time of transplantation reduced urological complications. We carried out a chart review on renal transplant patients and noted which patients developed urinary tract infections (UTIs) with stents in place, and whether these infections ultimately affected transplant outcome. We sought to distinguish subgroups of patients who were more likely to develop infection and to identify the optimum time for stent removal. PATIENTS AND METHODS: We performed a retrospective chart review of 213 patients who underwent renal transplantation in 1994 and 1995. Adequate follow-up information was available on 167 patients with intraoperative stent placement. Of these 167 patients, 4 patients expired and 8 required transplant nephrectomy due to complications unrelated to the stent. RESULTS: In total, 35 patients (22.6%) developed a post-operative UTI. One infection occurred during the first week following transplant, 3 developed within 2 weeks, and importantly, the remaining 32 infections occurred more than 2 weeks after transplant. An increase in infections in diabetics (25.7%) as compared to other transplant recipients (20.2%) was noted. Patients with cadaveric renal transplants are also at higher risk of UTI (24%) compared to those with living related donors (15%). CONCLUSION: The use of ureteral stents is safe, but is associated with a UTI rate of 22.6%. To reduce infection rates, we recommend stent removal within 14 days and earlier if possible, particularly in diabetic patients who have received a cadaveric renal transplant.