Sunday June 30, 2019 from 07:30 to 09:00
Ureteral strictures in kidney transplant recipients: Trends and severity
Michelle Minkovich1, Tierza Johnson1, Wendi Qu1, Olusegun Famure1, Yanhong Li1, S. Joseph Kim1,2, Jason Lee1,3.
1UHN Transplant Program, University Health Network, Toronto, ON, Canada; 2Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada; 3Division of Urology, Department of Medicine, University of Toronto, Toronto, ON, Canada
Introduction: Ureteral complication post-kidney transplant can be a significant morbidity, often requiring invasive re-operations to repair leaks and strictures and potentially impacting graft function.1,2 This puts patients at risk for outcomes such as graft rejection and increases healthcare burden.3 We investigated the incidence, trends in severity and treatment of ureteral strictures among kidney transplant recipients (KTR) in a large transplant centre.
Methods: We conducted a single-centre, retrospective cohort study of KTR transplanted from January 1, 2005 to March 31, 2017 with a one-year followup period (n=1782). Non-kidney and simultaneous multiorgan transplants were excluded. Trends in severity of, and treatments for, ureteral strictures were examined. We used logistic regression models to conduct a risk factor analysis of ureteral strictures.
Results: The incidence of ureteral strictures in the first year post-transplant was 2.63 per 100 person-years (95% confidence interval [CI] 1.96, 5.53). Extended criteria donor (ECD) KTR had a significantly higher incidence than non-ECD KTR (p=0.0081). The mean number of days to resolution was 32±6.9 days for simple events (strictures that resolved with one intervention), and 133±22.7 days for complex events (required more than one intervention). Percutaneous nephrostomy was the most common initial treatment. In recent years, open surgery has become more frequent as an intervention. Lastly, some identified risk factors included recipient history of peripheral vascular disease (odds ratio [OR] 2.40; 95% CI 1.05, 5.49; p= 0.038) and longer duration until stent removal in days (OR 1.002; 95% CI 1.001, 1.003; p=0.032).
Conclusions: Factors associated with ureteral strictures include recipient history of peripheral vascular disease and longer duration until stent removal. Targeting patients at risk may help reduce the incidence of complex events and the need to resort to open surgery as a treatment. Future steps include studying relationships between ureteral strictures and clinical outcomes.
 Krajewski W, Dembowski J, Kołodziej A, et al. Urological complications after renal transplantation: A single-centre experience. Cent Eur J Urol 2016;69:306-11.
 Berli JU, Montgomery JR, Segev DL, et al. Surgical management of early and late ureteral complications after renal transplantation: Techniques and outcomes. Clin Transplant 2014;29:26-33. https://doi.org/10.1111/ctr.12478
 Kumar S, Jeon JH, Hakim A, et al. Long-term graft and patient survival after balloon dilation of ureteric stenosis after renal transplant: A 23-year retrospective, matched-cohort study. Radiology 2016;281:301-10. https://doi.org/10.1148/radiol.2016151629