ELECTIVE JJ STENT REMOVAL (EJJR) IN KIDNEY TRANSPLANTATION: IS ROUTINE ULTRASOUND (US) USEFUL?

ABSTRACT

BACKGROUND AND AIMS: Transplantation (KTx) is considered the best renal replacement therapy nephrologists can offer and improving its outcomes remains a primary challenge in our field. KTx ureteral JJ stenting has been used to prevent urological complications, but there is no consensus about its elective removal timing and literature regarding routine US imaging after EJJR to detect complications is lacking. Our aim was to define the incidence of urological complications diagnosed by routine US after EJJR in KTx, determine US utility and best time interval to perform it. METHOD: We retrospectively analyzed 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 in the study period, 62.9% of receptors were male, 81.7% had a first KTx and 91.5% of organs 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. • Table1 summarizes the outcomes of complications detected • Cumulative frequency analysis of complications post EJJR showed the highest diagnostic yield was around day 10 post removal (Figure 1). 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 elective removal. Interventional nephrologists could do this examination promptly. (Table Presented).