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Ooms LSS, Minnee RC, Dor FJMF, Kimenai DJAN, Tran KCK, Hartog H, van de Wetering J, Willemsen SP, IJzermans JNM, Terkivatan T. Stenting the ureteroneocystostomy reduces urological complications in kidney transplantation: a noninferiority randomized controlled trial, SPLINT trial. Transpl Int 2020; 33:1190-1198. [PMID: 32403158 DOI: 10.1111/tri.13638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/06/2019] [Accepted: 05/04/2020] [Indexed: 12/16/2022]
Abstract
The role of ureteral stents in living-donor kidney transplantation remains uncertain. In this randomized controlled trial (SPLINT), we compared urological complications in living-donor kidney transplantations performed with or without stents. We included 200 consecutive patients that received living-donor kidney transplantations at the Erasmus MC, University Medical Center, Rotterdam. Patients (124 males, 76 females, mean age 54 ± 13) were randomized for suprapubic externalized single J stents (N = 100) or no stent (N = 100). The primary outcome was the probability of a percutaneous nephrostomy insertion (PCN) during a 12-month follow-up. To assess whether no stenting is noninferior to stenting, we allowed the probability of a PCN to increase by at most 5% (this is the noninferiority margin). Baseline characteristics were comparable between groups. In the no-stent group, there were more PCN insertions, 14% (95% CI 4.3-23.7%); urinary leakages, 12% (95% CI 5.4-21.3%); and surgical re-interventions because of urological complications, 8% (95% CI 1.5-14.5%). The stent group had more hematuria, 26% (95% CI 13.1-38.9%); and graft rejections, 15% (95% CI 2.7-27.3%). Patients in both groups had similar mean GFRs at several time points. Besides a better Euro-Qol-5D in the no-stent group at 2 and 6 weeks postoperative, similar quality of life was reported based on SF-36 and Euro-Qol-5D scores. In this trial, noninferiority has not been demonstrated for no-stent placement in relation to the number urological complications.
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Affiliation(s)
- Liselotte S S Ooms
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert C Minnee
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diederik J A N Kimenai
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Khe C K Tran
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hermien Hartog
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Turkan Terkivatan
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Bzoma B, Kostro J, Hellmann A, Chamienia A, Hać S, Dębska-Ślizień A, Śledziński Z. Ureteric Stenting in Kidney Transplant Recipients, Gdansk Centre Experience, Poland. Transplant Proc 2018; 50:1858-1862. [DOI: 10.1016/j.transproceed.2018.02.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/04/2018] [Accepted: 02/19/2018] [Indexed: 01/10/2023]
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Fockens MM, Alberts VP, Bemelman FJ, Laguna Pes MP, Idu MM. Internal or External Stenting of the Ureterovesical Anastomosis in Renal Transplantation. Urol Int 2015; 96:152-6. [PMID: 26535578 DOI: 10.1159/000440702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/27/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stenting of the ureterovesical anastomosis reduces the incidence of urological complications (UCs) after renal transplantation, but there are multiple stenting techniques, and there is no consensus regarding which technique is preferred. The aim of this study was to compare an internal versus an external stenting technique on the incidence of UCs. METHODS This is a retrospective analysis of 419 deceased donor renal transplantations performed between January 2008 and December 2013. Until 2011, 183 patients received an external stent through the ureterovesical anastomosis placed by suprapubic bladder puncture (SP stent). From 2011, 236 recipients received an internal double-J (JJ) stent. RESULTS The rate of UC was 3.8% in JJ stents, compared to 9.3% in SP stents (p = 0.021). No difference in surgical ureter revision rate was observed between the groups (2.1 vs. 5.5%; p = 0.068). Urinary tract infection (UTI) rate and graft function were comparable between both groups. CONCLUSIONS Internal JJ stenting significantly decreased the incidence of UC compared to an external SP stent. There was no difference in surgical ureter revision rate, UTI or graft function.
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Affiliation(s)
- M Matthijs Fockens
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Ooms LSS, Slagt IKB, Dor FJMF, Kimenai HJAN, Tran KTC, Betjes MGH, IJzermans JNM, Terkivatan T. Ureteral length in live donor kidney transplantation; Does size matter? Transpl Int 2015. [PMID: 26211787 DOI: 10.1111/tri.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the role of ureteral length on urological complications. Data were retrospective collected from the INEX-trial database, a RCT to compare the intravesical to the extravesical ureteroneocystostomy. Ureteral length was measured in 198 recipients and used to divide recipients into three categories based on interquartile ranges: short (≤8.5 cm), medium (8.6-10.9 cm) and long ureters (≥11 cm). Urological complications were defined as the number of percutaneous nephrostomy placements (PCN). Fifty recipients fell into the short, 98 into the medium and 50 recipients into the long ureter category. Median follow-up was 26 (range 2-45) months. There was no significant difference in number of PCN placements between the categories. There were 9 (18%) PCN placements in the short ureter category, 21 (20%) in medium ureter category and 10 (21%) in the long ureter category, P = 0.886. Risk factor analysis for gender, arterial multiplicity and type of ureteroneocystostomy showed no differences in PCN placements between the three ureteral length categories. We conclude that ureteral length alone does not seem to influence the number of urological complications.
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Affiliation(s)
- Liselotte S S Ooms
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Inez K B Slagt
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Khe T C Tran
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Türkan Terkivatan
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Ureteral Stent Placement Increases the Risk for Developing BK Viremia after Kidney Transplantation. J Transplant 2014; 2014:459747. [PMID: 25295178 PMCID: PMC4177822 DOI: 10.1155/2014/459747] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 08/05/2014] [Accepted: 08/21/2014] [Indexed: 12/16/2022] Open
Abstract
The placement of ureteral stent (UrSt) at kidney transplantation reduces major urological complications but increases the risk for developing nephropathy from the BK virus. It is unclear whether UrSt placement increases nephropathy risk by increasing risk of precursor viral replication or by other mechanisms. We retrospectively investigated whether UrSt placement increased the risk for developing BK Viremia (BKVM) in adult and pediatric kidney transplants performed at the University of Florida between July 1, 2007, and December 31, 2010. In this period all recipients underwent prospective BKV PCR monitoring and were maintained on similar immunosuppression. Stent placement or not was based on surgeon preference. In 621 transplants, UrSt were placed in 295 (47.5%). BKVM was seen in 22% versus 16% without UrSt (P = 0.05). In multivariate analyses, adjusting for multiple transplant covariates, only UrSt placement remained significantly associated with BKVM (P = 0.04). UrSt placement significantly increased the risk for BKVM. Routine UrSt placement needs to be revaluated, since benefits may be negated by the need for more BK PCR testing and potential for graft survival-affecting nephritis.
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Slagt IKB, IJzermans JNM, Visser LJ, Weimar W, Roodnat JI, Terkivatan T. Independent risk factors for urological complications after deceased donor kidney transplantation. PLoS One 2014; 9:e91211. [PMID: 24608797 PMCID: PMC3946700 DOI: 10.1371/journal.pone.0091211] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 02/09/2014] [Indexed: 02/07/2023] Open
Abstract
Urological complications after kidney transplantation are mostly related to the ureteroneocystostomy, often requiring interventions with additional costs, morbidity and mortality. Our aim was to assess risk factors for urological complications in deceased donor kidney transplantation. Between January 2000 and December 2011, 566 kidney transplantations were performed with deceased donor kidneys. Recipients were divided in a group with, and a group without urological complications, defined as the need for a percutaneous nephrostomy catheter or surgical revision of the ureteroneocystostomy. Univariate and multivariate analyses were performed. Univariate analysis showed increased number of male donors (p = 0.041), male recipients (p = 0.002), pre-emptively transplanted recipients (p = 0.007), and arterial reconstructions (p = 0.004) in the group with urological complications. Less urological complications occurred in recipients on hemodialysis (p = 0.005). More overall surgical interventions (p<0.001), surgical site infections (p = 0.042), urinary tract infections (p<0.001) and lymphoceles (p<0.001) occurred in the group with urological complications. Multivariate analysis showed that male recipients (p = 0.010) and arterial reconstructions (p = 0.019) were independent risk factors. No difference was found between both groups in patient or graft survival. In conclusion, recipient male gender and arterial reconstruction are independent risk factors for urological complications after deceased donor kidney transplantation. Nevertheless, graft and recipient survival is not different between both groups.
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Affiliation(s)
- Inez K. B. Slagt
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Laurents J. Visser
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Division of Nephrology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Joke I. Roodnat
- Department of Internal Medicine, Division of Nephrology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Türkan Terkivatan
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- * E-mail:
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Slagt IK, Dor FJ, Tran TK, Kimenai HJ, Weimar W, IJzermans JN, Terkivatan T. A randomized controlled trial comparing intravesical to extravesical ureteroneocystostomy in living donor kidney transplantation recipients. Kidney Int 2014; 85:471-7. [DOI: 10.1038/ki.2013.464] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 11/09/2022]
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Damji S, Atinga A, Hakim D, Hakim N. Ureteric Stenting in Kidney Transplants. EXP CLIN TRANSPLANT 2013; 11:109-11. [DOI: 10.6002/ect.2012.0270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Long-term outcome of kidney transplantation in patients with a urinary conduit: a case-control study. Int Urol Nephrol 2013; 45:405-11. [PMID: 23408323 DOI: 10.1007/s11255-013-0395-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To study the short- and long-term outcomes of kidney transplantation in patients with a bladder augmentation or urinary diversion compared to patients with a kidney transplantation in a normal functional bladder. PATIENTS AND METHODS Between January 2000 and March 2011, 13 patients received 16 grafts into a reconstructed urinary tract. We performed a retrospective case-control study and matched each patient to 4 controls for donor and recipient gender and year of transplantation. RESULTS Short- and long-term complications of kidney transplantation occurred in 12 patients, varying from urinary tract infections to medical hospitalization with or without surgical or radiological intervention. In 5 patients, a percutaneous nephrostomy (PCN) was placed followed by surgical re-intervention. In three patients, the grafts failed as a result of chronic rejection and were re-transplanted. There was no graft loss as a result of surgical complications or the reconstructed urinary tract. One-year patient and graft survival was 100 %. After five years, all patients were alive and seven of nine grafts (77.8 %) were functioning. Mean follow-up time was 4.3 years. Among the controls, 55 grafts were transplanted in 52 patients. Ten patients received a PCN. Five patients needed surgical re-intervention. In three patients, transplantectomy was performed for ongoing rejection. Three patients were re-transplanted. One patient had a failing graft 7.5 years post-transplantation and became dialysis dependent. CONCLUSION Kidney transplantation in patients with a reconstructed urinary tract has an increased complication rate. Nevertheless, the long-term results are comparable to patients with a normal urinary bladder.
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