Comparison of short versus long stent duration on outcomes after pediatric kidney transplantation: a systematic review by the Young Academic Urologists Pediatric Urology and Kidney Transplantation Working Groups

Introduction and objectives

Urological complications are common after kidney transplantation (KTx), mostly in the form of ureterovesical obstruction or leakage. Routine ureteral stenting was previously shown to reduce these complications on the expense of other complications such as urinary tract infections (UTI). There is no consensus on optimal duration of stents, and relevant literature on this topic is lacking. The aim of this systematic review is to summarize and compare the incidences of stent-related complications using short (<2 weeks; SD) and long (≥2 weeks; LD) stent duration after pediatric KTx.

Material and methods

A systematic search in Embase, MEDLINE, Cochrane, and clinicaltrial.gov was performed. Studies reporting on children (0–18 years) undergoing KTx with intraoperative ureteral stenting with at least one month follow up were included. Data on surgical and outcome characteristics were extracted.

Results

From a total of 322 articles, 14 studies were included, reporting on 971 pediatric KTx of whom 411 were female (42%). Sample sizes ranged from 32 to 146 patients. Mean or median age at time of transplantation ranged from 3.36 to 14.7 years. A systematic synthesis approach was used to summarize results. Of the four comparative studies, only one showed significantly more post-transplant UTIs in the LD group, without a significant difference in other urological complications.

Conclusions

Due to lack of good quality studies, it remains uncertain whether a short stent duration is safer and more feasible for reducing the incidence of stent-related complications in pediatric KTx, while also preventing stenosis or leakage at the ureterovesical anastomosis.