[Predisposing factors for ureteric strictures in renal transplantation]

Renal transplantation is a well defined surgical procedure, but it nevertheless remains associated with a risk of medical and surgical complications. Ureteric strictures, with an incidence ranging from 2% to 7.5% according to the series, are the most frequent urological complication. The objective of this study was to determine the incidence of ureteric strictures and the existence of risk factors predisposing to the development of ureteric strictures and to evaluate their consequences on patient and graft survival, based on a single-centre retrospective series of renal transplantations.

From January 1990 to December 2002, 1787 renal transplantations were performed consecutively in our centre. Graft, donor and recipient characteristics were extracted from a computerized database and validated by an independent observer. The parameters studied included donor's age and recipient's age, donor's haemodynamic status and serum creatinine at the time of harvesting, cause of death, graft weight and number of graft arteries, cold ischaemia and reperfusion times, number of HLA incompatibilities and percentage anti-HLA immunization, time to return of graft function, acute rejection, presence or absence of a double J stent, episodes of acute pyelonephritis, CMV infection and patient and graft survival according to the Kaplan-Meier method.

Ureteric stricture was observed in 74 patients (4.1% of cases) and a donor age greater than 65 years (p < 0.0001), the presence of more than 2 arteries on the graft (p = 0.03) and recipients with an anti-HLA immunization less than 25% (p = 0.037) were identified as independent risk factors. Furthermore, grafts complicated by ureteric stricture resumed function later (p = 0.001). The development of ureteric stricture did not have an unfavourable impact on the 10-year recipient and graft survival rates.