Routine intraoperative ureteric stenting for kidney transplant recipients

Area of Science:

• Urology
• Transplantation Surgery
• Nephrology

Background:

• Major urological complications (MUCs) are a significant concern following kidney transplantation, impacting patient morbidity and graft function.
• Vesicoureteric anastomosis is the primary source of MUCs, often presenting early post-transplant.
• Ureteric stents are employed to manage these complications, with varying center policies on prophylactic use.

Approach:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs evaluating ureteric stenting in kidney transplant recipients.
• Searches conducted across multiple databases including CENTRAL, MEDLINE, and EMBASE up to June 2024.
• Data synthesized using random-effects models, with results expressed as risk ratios (RR) and 95% confidence intervals (CI); evidence certainty assessed by GRADE.

Key Points:

• Universal prophylactic ureteric stenting likely reduces MUCs (RR 0.30, 95% CI 0.16 to 0.55) with moderate certainty evidence.
• This benefit extends to individual MUC components like urine leak and ureteric obstruction, regardless of stent duration (≤14 days or >14 days).
• The impact on urinary tract infection (UTI) remains uncertain (RR 1.32, 95% CI 0.97 to 1.80), though short-duration stenting and co-trimoxazole did not increase UTI risk.

Conclusions:

• Routine prophylactic ureteric stenting appears effective in reducing MUCs post-kidney transplantation, even with short stent durations.
• Further high-quality research is needed to determine optimal stent duration and compare selective versus universal prophylactic stenting.
• Long-term stent use may increase risks of encrustation and migration; graft survival and other complications require further investigation.