ABSTRACT
Introduction: Transplantation (KTx) is considered the best renal replacement therapy and improving its outcomes remains a primary challenge. KTx ureteral JJ stenting has been used to prevent urological complications, but there is no consensus about EJJR timing and literature regarding routine US imaging after EJJR to detect complications is lacking. Aim: Define the incidence of urological complications diagnosed by routine US after EJJR in KTx, determine US utility and best time interval to perform it. Methods: We retrospectively analysed all routine KTx US performed in our Unit from 2016 until 2020 by an experienced interventional nephrologist. US post EJJR findings were compared with previous patient US. KTx characteristics, treatment and outcomes were recorded. Results: - 345 KTx were done, 62.9% were male receptors, 81.7% had a first KTx and 91.5% were from a deceased donor. No routine US post EJJR was done in 20.9% due to the COVID pandemic. - Mean timing to elective JJ stent removal was 36.4 ± 25 days (SD). - Mean time from EJJR to US was 16.3 ± 28.8 days (SD). - Urinary tract (UT) ectasia (19.7%) and grade I UT dilatation (3.6%) were not considered pathological. - 47.3% (129) had a complication detected: 88.4% (114) had a collection, 8.5% (11) had UTD: 5.4% grade II and 3.1% grade III. 3% had other complications. Conclusion: Routine US after EJJR allowed a timely diagnosis and early treatment of urological complications, a key factor for successful transplantation. KTx US is a cost - effective and reproducible test that provides crucial information to guide clinical decisions, being most efficient when performed 10 days post removal. Interventional nephrologists could do this examination promptly.
ABSTRACT
Background: Improving kidney transplant (KTx) outcomes remains a primary challenge and KTx ureter JJ stenting has been used to prevent urological complications. There is no consensus about EJJR timing, and literature regarding routine US imaging after EJJR to detect complications is lacking. Methods: We retrospectively analysed all routine KTx US done in our Unit from 2016-2020 by an experienced interventional nephrologist. US post EJJR findings were compared with previous US. KTx characteristics, treatment and outcomes were recorded. We aimed to define incidence of urological complications diagnosed, US utility and best time interval to perform it. Results: 345 KTx were done: 62.9% were male receptors, 81.7% had a first KTx and 91.5% of the organs were from a deceased donor. No routine US post EJJR was done in 20.9% due to COVID pandemic. Mean timing to elective JJ stent removal was 36.4 ± 25 days (SD). Mean time from EJJR to US was 16.3 ± 28.8 days (SD). Urinary tract ectasia was not considered pathological. Of those with an US, 45.1% (123) had a complication detected: 41.4% had a newly diagnosed collection and 21% had urinary tract dilatation (UTD): 10% grade I UTD. 6% grade II UTD. 5% grade III UTD. Of the 123 patients with a complication, 3 required a surgical approach, 2 had a drainage inserted, 2 nephrostomies, 11 required admission without surgical intervention and 51 had US follow up. Cumulative frequency analysis of complications post EJJR showed the highest diagnostic yield of US imaging was around day 10 post removal (figure 1). Conclusions: Routine US after EJJR allowed timely diagnosis and early treatment of urological complications, a key factor for successful transplantation. KTx US is an effective, cheap and reproducible test that provides crucial information to guide clinical decisions, being most effective when performed 10 days post stent removal. Interventional nephrologists could do this examination promptly.