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Sosa Barrios RH, Burguera Vion V, Villa Hurtado D, Viera Ramírez ER, Galeano Álvarez C, Roncal Redín M, Fernández Lucas M, Rivera Gorrín ME. Routine Kidney Graft Ultrasound After Elective Ureteric Stent Removal: Does it Help? Transplant Proc 2024; 56:310-315. [PMID: 38365514 DOI: 10.1016/j.transproceed.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
Transplantation (KTx) is considered to be the best renal replacement therapy, and improving its outcomes remains a primary challenge. KTx ureteral stenting has been used to prevent urological complications, but there is no consensus on the timing of stent removal, and literature regarding routine ultrasonography after ureteric stent removal (RUSUS) to detect complications is lacking. Point-of-care ultrasound has been gaining drive in the medical community in recent years, including nephrologists. We aimed to define the incidence of urological complications diagnosed with RUSUS, if those findings changed patient's management and ultrasound utility. Contrary to previously published data, in our cohort RUSUS allowed a timely diagnosis and early treatment of urological complications, a key factor for successful transplantation. KTx point-of-care ultrasound is a cost-effective and reproducible test that provides relevant information to guide clinical decisions, seeming most efficient when performed approximately 2 weeks post ureteral stent removal. Interventional nephrologists can promptly perform these examinations, reducing waiting times and improving graft and patient's survival.
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Affiliation(s)
- R Haridian Sosa Barrios
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, UAH, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN).
| | - Víctor Burguera Vion
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
| | - Daniel Villa Hurtado
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
| | | | - Cristina Galeano Álvarez
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
| | - Miriam Roncal Redín
- Preventive Medicine and Public Health Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Milagros Fernández Lucas
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, UAH, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
| | - Maite E Rivera Gorrín
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, UAH, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
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Hussein A, Sran K, Ali I, Woellner J, Wilcox H, Marks SD, Jones H, Callaghan C. No evidence for the need of a routine renal transplant ultrasound after elective transplant ureteric stent removal-A retrospective cohort study. Pediatr Transplant 2020; 24:e13704. [PMID: 32255548 DOI: 10.1111/petr.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/19/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022]
Abstract
Transplant ureteric stent insertion reduces the incidence of MUCs, but it is not known whether routine PSRGU is needed to detect unmasked MUCs. This study evaluated whether routine PSRGU in the pRTR is a useful tool to identify MUCs before they become clinically apparent. A retrospective analysis was undertaken of the clinical outcomes following elective stent removal from pediatric kidney-only transplant recipients at two London centers between 2012 and 2016. Our policy was to perform PSRGU either routinely or urgently if there were concerning symptoms or biochemical evidence of renal allograft dysfunction. Elective stent removal was performed in 86% (97 of 113 pRTR), and 75 (77%) of whom had routine PSRGU at a median (IQR) of 6 (2-8) days after stent removal. There were changes to management in 3 (4%) of pRTR with PSRGU identifying no MUC. Nineteen patients (25%) had urgent PSRGU, most commonly due to renal allograft dysfunction, at a median (IQR) of 5.5 (2.7-12.3) days after stent removal. Of these, two pRTR required ureteric intervention. For our current practice of removing transplant stents at 4-6 weeks post-transplantation, our study has found no evidence to support routine PSRGU after elective stent removal.
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Affiliation(s)
- Aliyah Hussein
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kiran Sran
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Imran Ali
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Janine Woellner
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Helen Wilcox
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Helen Jones
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Complications chirurgicales de la transplantation rénale. Prog Urol 2016; 26:1066-1082. [DOI: 10.1016/j.purol.2016.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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