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Assessing the value of ureteral stent placement in pediatric kidney transplant recipients
Vikas R Dharnidharka1, Carlos E Araya, Christopher S Wadsworth
1Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA. vikasmd@peds.ufl.edu
Insights
Ureteral stent placement in pediatric kidney transplants increases early urinary tract infection risk. Stents do not prevent stenosis or leakage and may add costs, suggesting routine use needs reevaluation.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Urology
Background:
- Ureteral stents in kidney transplantation may reduce stenosis/leakage but risk early urinary tract infection (UTI) and BK virus allograft nephropathy (BKVAN).
- The role of ureteral stents in pediatric kidney transplantation remains unclear.
Purpose of the Study:
- To evaluate the impact of ureteral stent placement on early UTI, stenosis/leakage (S/L), and BK virus allograft nephropathy (BKVAN) in pediatric kidney transplant recipients.
Main Methods:
- Retrospective analysis of 129 pediatric kidney transplants performed between 1996 and 2006.
- Stent placement decisions were based on surgeon preference.
- Statistical analyses included univariate and multivariate models, and Cox regression for BKVAN.
Main Results:
- Stent placement was a significant risk factor for early UTI (P=0.0399) but did not reduce S/L rates (P=0.23).
- Multivariate analysis identified stent placement, HLA match, and bladder augmentation as risk factors for early UTI.
- Warm ischemia time, not stent placement, was the primary risk factor for BKVAN; stents did not improve graft survival.
Conclusions:
- Routine ureteral stent placement in pediatric kidney transplantation warrants reevaluation due to increased early UTI risk and lack of benefit for S/L or BKVAN.
- Stent removal requires anesthesia, adding cost and risk, further questioning routine use in children.
Background:
Ureteral stent placement at kidney transplantation may reduce stenosis or leakage (S/L) complication rates. However, stent placement may also increase risk for early urinary tract infection (early UTI; <3 months after transplant) and BK virus allograft nephropathy (BKVAN). In children, the usefulness of stent placement is not well defined.
Methods:
We analyzed retrospective data from children transplanted at our center for the three above outcomes in relation to stents. At our center, stent placement decision is driven by surgeon preference.
Results:
Among 129 transplants from 1996 to 2006, early UTI was seen in 9.3% and S/L in 4.6%. By univariate analyses, stent placement was a significant risk factor for early UTI (P=0.0399) but not protective for S/L (P=0.23). In multivariate analyses, stent placement, human leukocyte antigen match, and bladder augmentation increased the odds ratio for early UTI. Only deceased donor source increased the odds ratio for S/L. In a truncated data set from 1999 to 2006, BKVAN occurred in 9 of 93 (9.6%). Per minute increase in warm ischemia time was the only significant risk factor for BKVAN by both univariate and Cox regression analyses. Stent placement did not improve graft survival (P=0.5726) but required general anesthesia for removal in the operating room, leading to additional cost and potential risk.
Conclusion:
Routine stent placement in children in this era of low urological complication rates and BKVAN needs reevaluation.
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