Jenny Lam, Ibrahim Elali, Mohammed Mahgoub, Esma Kesik, Byron Smith, Esther Ovdat, Patricia Rebolledo, Weslyn Bunn, Carrie Jadlowiec, Kunam Reddy, Shennen Mao, Dana Perry, Andrew Bentall, Carrie Schinstock, Mikel Prieto, Scott Nyberg, Mark D. Stegall
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引用次数: 0
Abstract
Background
Ureteral stents are commonly placed during kidney transplantation (KT) to mitigate urologic complications. The objective of this study was to compare clinical outcomes in KT recipients with either early stent removal when attached to the Foley catheter or late removal via cystoscopy when unattached.
Methods
We conducted a multi-center retrospective analysis of consecutive living donor KT patients (8/18/21-4/21/23) stratified into Foley-attached and unattached stent groups. Outcomes assessed were ureteral stricture, urine leaks, UTIs at 90 days and allograft failure and BKV DNAemia (BK virus DNAemia) at 1 year. Data are reported as mean and standard deviation.
Results
Among 247 patients with attached and 260 with unattached stents, baseline demographics (age, sex, diabetes) were similar between groups. There was a difference in race (87.9% vs. 77.8% Caucasian; p = 0.004). Foley catheters remained longer in the attached group (3.7 ± 1.8 vs. 3.0 ± 2.0 days; p < 0.001), but stents were removed earlier (3.7 ± 1.8 vs. 21.9 ± 4.7 days; p < 0.001). Comparing attached versus unattached, there were no differences in ureteral stricture (0.4% vs. 1.5%; p = 0.197), urine leak (0.8% vs. 0.4%; p = 0.533), BKV DNAemia (17.7% vs. 16.9%; p = 0.616), or allograft failure (0% vs. 0.8%; p = 0.167). However, UTI incidence by 90 days was lower in the attached group (5.7% vs. 11.9% p = 0.013). Induction therapy differed significantly between groups, with Alemtuzumab more common in the unattached group (58.1% vs. 19.4%, p < 0.001), Basiliximab more common in the attached group (43.3% vs. 35.0%, p < 0.001), and Thymoglobulin more common in the attached group (36.0% vs. 6.9%, p < 0.001). Baseline steroid use was higher in the unattached group (81.9% vs. 57.9%, p < 0.001).
Conclusion
Early stent removal via connection to the Foley catheter had similarly low rates of ureteral complications while reducing urinary tract infections and avoiding cystoscopic removal.
背景：输尿管支架通常在肾移植（KT）中放置，以减轻泌尿系统并发症。本研究的目的是比较连接Foley导管的早期支架移除和未连接Foley导管的晚期膀胱镜移除的KT受者的临床结果。方法：我们对连续活体供体KT患者（8/18/21-4/21/23）进行多中心回顾性分析，将其分层为foley支架贴附组和未贴附组。评估的结果是输尿管狭窄、尿漏、90天的尿路感染、同种异体移植失败和1年的BKV dna血症（BK病毒dna血症）。数据以平均值和标准差报告。结果：247例置入支架的患者和260例未置入支架的患者，两组间的基线人口统计学特征（年龄、性别、糖尿病）相似。种族差异（87.9% vs. 77.8%高加索人；p = 0.004）。附着组Foley导管停留时间较长（3.7±1.8∶3.0±2.0天；p < 0.001），但支架移除时间较早（3.7±1.8∶21.9±4.7天；p < 0.001）。在输尿管狭窄（0.4% vs. 1.5%, p = 0.197）、尿漏（0.8% vs. 0.4%, p = 0.533）、BKV dna血症（17.7% vs. 16.9%, p = 0.616）或同种异体移植失败（0% vs. 0.8%, p = 0.167）方面，附着组与未附着组比较无差异。然而，联合用药组90天的UTI发生率较低（5.7%比11.9% p = 0.013）。诱导治疗组间差异显著，阿仑单抗在未连接组中更常见（58.1% vs. 19.4%）。结论：通过连接Foley导管早期支架取出输尿管并发症发生率同样较低，同时减少尿路感染并避免膀胱镜取出。
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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