Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration
Por:
Territo, A, Bravo-Balado, A, Andras, I, Campi, R, Pecoraro, A, Hevia, V, Prudhomme, T, Baboudjian, M, Gallioli, A, Verri, P, Charbonnier, M, Boissier, R, Breda, A
Publicada:
20 jun 2023
Ahead of Print:
1 jun 2023
Resumen:
PurposeUreteral stenosis (US) in kidney transplant (KT) recipients is associated with poorer long-term graft survival. Surgical repair is the standard of care, and endoscopic treatment represents an alternative for stenosis < 3 cm. We aimed to determine the effectiveness and safety of endourological management of US in KT patients and predictors of failure.MethodsA retrospective multicenter study was conducted in four European referral centers, including all KT patients with US managed endoscopically between 2009 and 2021. Clinical success was defined as the absence of upper urinary tract catheterization, surgical repair or transplantectomy during follow-up.ResultsA total of 44 patients were included. The median time to US onset was 3.5 months (IQR 1.9-10.8), the median length of stricture was 10 mm (IQR 7-20). Management of US involved balloon dilation and laser incision in 34 (79.1%) and 6 (13.9%) cases, respectively, while 2 (4.7%) received both. Clavien-Dindo complications were infrequent (10%); only one Clavien >= III complication was reported. Clinical success was 61% at last follow-up visit (median = 44.6 months). In the bivariate analysis, duckbill-shaped stenosis (vs. flat/concave) was associated with treatment success (RR = 0.39, p = 0.04, 95% CI 0.12-0.76), while late-onset stenosis (> 3 months post KT) with treatment failure (RR = 2.00, p = 0.02, 95% CI 1.01-3.95).ConclusionsConsidering the acceptable long-term results and the safety of these procedures, we believe that the endoscopic treatment should be offered as a first-line therapy for selected KT patients with US. Those with a short and duckbill-shaped stenosis diagnosed within 3 months of KT seem to be the best candidates.
Filiaciones:
Territo, A:
Fundacio Puigvert, Dept Urol, Carrer Cartagena 340, Barcelona 08025, Spain
Autonomous Univ Barcelona, Carrer Cartagena 340, Barcelona 08025, Spain
Bravo-Balado, A:
Fundacio Puigvert, Dept Urol, Carrer Cartagena 340, Barcelona 08025, Spain
Autonomous Univ Barcelona, Carrer Cartagena 340, Barcelona 08025, Spain
Andras, I:
Iuliu Hatieganu Univ Med & Pharm, Urol Dept, Cluj Napoca, Romania
Campi, R:
Careggi Univ Hosp, Unit Urol Robot, Minimally Invas Surg & Renal Transplantat, Florence, Italy
Univ Florence, Dept Expt & Clin Med, Florence, Italy
Pecoraro, A:
Careggi Univ Hosp, Unit Urol Robot, Minimally Invas Surg & Renal Transplantat, Florence, Italy
Hevia, V:
Alcala Univ, Hosp Univ Ramon y Cajal, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Prudhomme, T:
Toulouse Univ Hosp, Dept Urol & Kidney Transplantat, Toulouse, France
Baboudjian, M:
Fundacio Puigvert, Dept Urol, Carrer Cartagena 340, Barcelona 08025, Spain
Autonomous Univ Barcelona, Carrer Cartagena 340, Barcelona 08025, Spain
CHU Conception Hosp, AP HM, Dept Urol & Kidney Transplantat, 146 Blvd Baille, F-13005 Marseille, France
Gallioli, A:
Fundacio Puigvert, Dept Urol, Carrer Cartagena 340, Barcelona 08025, Spain
Autonomous Univ Barcelona, Carrer Cartagena 340, Barcelona 08025, Spain
Verri, P:
Fundacio Puigvert, Dept Urol, Carrer Cartagena 340, Barcelona 08025, Spain
Charbonnier, M:
CHU Conception Hosp, AP HM, Dept Urol & Kidney Transplantat, 146 Blvd Baille, F-13005 Marseille, France
Boissier, R:
CHU Conception Hosp, AP HM, Dept Urol & Kidney Transplantat, 146 Blvd Baille, F-13005 Marseille, France
Breda, A:
Fundacio Puigvert, Dept Urol, Carrer Cartagena 340, Barcelona 08025, Spain
Autonomous Univ Barcelona, Carrer Cartagena 340, Barcelona 08025, Spain
hybrid, All Open Access, Hybrid Gold
|