Stents May Benefit Renal Transplant Patients

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Recipients of deceased donor kidneys who have ureteral stents implanted are at lower risk of ureteral complications, but are more likely to experience urinary tract infection (UTI), according to researchers.

In a study of 961 renal transplant recipients—310 with ureteral stents and 651 without the stents—investigators found that the ureteral complication rate was 1.9% in stent recipients compared with 5.8% of those without stents. After adjusting for confounders, the stent group overall had a significant 60% decreased risk of ureteral complications. Further analysis revealed, that stents benefited primarily recipients of deceased donor kidneys with 66% decreased risk of ureteral complications compared to non-stented recipients, investigators reported online ahead of print in Transplantation.

“Routine stenting in deceased donor transplants is recommended as its protective effect was observed in this group,” the authors concluded.

The protective effect of stents was related primarily to a significant reduction in stricture but not leak. “We speculate that the stent affects the healing process in the early postoperative period in such a way that stricture is less likely to occur at a later time point,” Sameh A. Fayek, MD, and colleagues at the University of Maryland School of Medicine in Baltimore, stated.

Deceased donor kidneys are more prone to ischemic insult secondary to long cold ischemia time and as certain donor characteristics, such as age and diabetes mellitus with possible microvasculature disease. This insult is manifested by the higher delayed graft function rate in the stent group than in the no-stent group (46% vs. 28.6%), the authors noted.

The UTI rate was 14.2% in the stent group compared with 7.9% in the no-stent group, a difference that translated into a significant 79% increased risk of UTI in the stent group, after adjusting for potential confounders. The finding of an increased UTI risk in renal transplant patients who had ureteral stents implanted is consistent with findings from previous studies, Dr. Fayek's group observed.

A major strength of the study was its relatively large cohort of both deceased and living donor recipients, the researchers said. However, the study is limited by its retrospective design and the fact that patients were operated on by different surgeons with variable practices and thresholds for stenting. According to the authors, the value of stents in recipients of living donor kidneys remains to be determined given the low rate of stent utilization in this group.

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