Management of Incidentally Detected Urinary Tract Calculus in Patients Awaiting Living Donor Liver Transplantation: A Protocol-Based Approach

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2024-12-01 DOI:10.1016/j.transproceed.2024.11.022

Anish Gupta , Yajvendra Pratapsingh Rana , Himanshu Kolhe , Gaurav Sood , Niteen Kumar , Imtiakum Jamir , Aditya Shriya , Vipin Pal Singh , Rekha Subramaniyam , Abhideep Chaudhary

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引用次数: 0

Abstract

Background

Urinary tract calculi (UTC) in patients awaiting living donor liver transplant (LDLT) requires proper management due to increased risk of infections in the post-liver transplant (LT) period.

Materials and Methods

A retrospective analysis of records of LDLT recipients with UTC was conducted between July 2019 and July 2023. No prisoners or paid participants were included.

Results

Thirty patients (25 women and 5 men) with a mean age of 44.45 ± 9.67 years, model of end stage liver disease with sodium (MELD-Na) of 20.5 ± 12.2 were diagnosed to have a UTC during pre-LT evaluation. Twenty-five patients had renal stones, whereas five patients had ureteric calculus (22 were unilateral and 8 were bilateral calculi). Fifteen patients underwent double J (DJ)-stenting prior to LT. The mean stone size in patients who underwent DJ stenting was 13.6 (±9.83) mm vs 4.78 (±5.3) mm in whom stenting was not done. Patients with preoperative DJ stenting had a significantly reduced hospital stay (18.5 ± 2.1 days), lower mortality rates (0%), and lower rates of hematuria (6.66%) vs (23.4 ± 12.8 days, 13.33% and 13.3%, respectively). Patients with preoperative DJ stenting underwent post-transplant definitive procedure for UTC without any complications.

Our Protocol for Incidentally Detected Ureteric Stones in LT Recipients:

a. Proximal-ureteric calculi: Preoperative DJ stenting (2-3 days prior/ on day of LT) → LT → ESWL/URS 2-3 weeks later → DJ stent removal after 2-3 weeks.

b. Distal-ureteric calculi: Preoperative DJ stenting ± URS (2-3 days prior/ day of LT) → LT → DJ stent removal after 2-3 weeks.

Our protocol for incidentally detected renal stones in LT recipients:

a. Stone size (< 5 mm) and nonobstructive calculi with no active UTI:

No surgical intervention → Liver transplant under antibiotics cover → medical management of stone.

b. Multiple calculi sized < 5 mm or single stone 5-10 mm:

DJ stent placement → LT → ESWL/RIRS after 4-6 weeks → DJ stent removal after 3 weeks.

c. Single stone size > 10 mm or multiple calculi > 5 mm:

DJ stent placement → LT → RIRS/PCNL after 4-6 weeks→DJ stent removal after 3-4 weeks.

Conclusion

A systemic minimally invasive approach is needed for pre-LT management of UTC for better patient outcomes.

查看原文本刊更多论文

等待活体肝移植患者意外发现尿路结石的处理：一种基于协议的方法。

背景：等待活体肝移植（LDLT）患者的尿路结石（UTC）需要适当的管理，因为肝移植后（LT）时期感染风险增加。材料和方法：回顾性分析2019年7月至2023年7月期间LDLT患者UTC的记录。不包括囚犯或付费参与者。结果：30例患者（女性25例，男性5例），平均年龄44.45±9.67岁，终末期含钠肝病模型（MELD-Na）为20.5±12.2，在肝移植前评估时诊断为UTC。25例患者有肾结石，5例患者有输尿管结石（22例为单侧结石，8例为双侧结石）。15例患者在lt之前接受了双J （DJ）支架植入术。接受DJ支架植入术的患者平均结石大小为13.6（±9.83）mm，而未接受支架植入术的患者平均结石大小为4.78（±5.3）mm。术前行DJ支架植入术的患者住院时间（18.5±2.1天）、死亡率（0%）和血尿率（6.66%）明显低于术前（23.4±12.8天、13.33%和13.3%）。术前植入DJ支架的患者接受移植后确定的UTC手术，无任何并发症。我们的方案是：a.输尿管近端结石：术前DJ支架置入（术前2-3天/当日）→LT→2-3周后ESWL/URS→2-3周后DJ支架取出。b.输尿管远端结石：术前DJ支架置入±URS（术前2-3天/ LT当日）→LT→2-3周后DJ支架取出。对于肝移植受者偶然发现的肾结石，我们的治疗方案是：a.结石大小（< 5mm），非梗阻性结石，无活动性尿路感染：无手术干预→抗生素覆盖下的肝移植→结石的医学处理。b.多发结石< 5mm或单个结石5-10 mm: 4-6周后置入DJ支架→LT→ESWL/RIRS→3周后取出DJ支架。c.单个结石>0 mm或多发结石> 5 mm: DJ支架置入→LT→4-6周后RIRS/PCNL→3-4周后DJ支架取出。结论：为了获得更好的患者预后，需要采用系统微创方法对UTC进行肝移植前治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.