Reconstructive versus palliative management of ureteral stenosis after kidney transplant: an EAU‑YAU kidney transplantation working group collaboration.

INTRODUCTION

Surgical redo of the anastomosis is the recommended treatment of ureteral stenosis (US) after kidney transplantation (KT), although some patients may only be candidates for palliative treatment by permanent urinary catheterization. We aimed to compare the functional results of these two approaches.

METHODS

This was a retrospective, multicenter study conducted at 3 academic centers. All patients presenting ureteral stenosis after kidney transplant treated by either surgical reconstruction or indwelling ureteral stent were included. Treatment allocation was established based on strictures characteristics and patient preference. The outcomes of each procedure and factors associated with success of reconstruction, graft failure and eGFR variation were analyzed by means of descriptive statistics.

RESULTS

30 (54.5%) and 24 (44.5%) patients underwent reconstructive and palliative treatment, respectively. Distal/ureterovesical location was most frequently observed (81.1%, p < 0.0001). Reconstruction consisted of ureterovesical reimplantation, pyeloureterostomy and ureteroureterostomy in 11 (36.6%), 13 (43.3%) and 3 (10.0%) cases, respectively. Intestinal segment interposition was employed in 2 (6.7%) cases. We observed 4 (13.3%) cases of failure after surgery and ureterovesical reimplantation was significantly associated with stricture recurrence (p = 0.018). A significant variation of eGFR from post treatment baseline to last follow-up was observed in the palliative group (43.5 ml/ min/ 1.73 m² to 32.0 ml/ min/ 1.73 m², p < 0.001), although graft survival was similar (91.9% vs. 90.0%, p = 0.65).

CONCLUSION

Surgical reconstruction can attain definitive treatment of post KT US in almost nine out of ten patients with a satisfactory safety profile. On the other hand, palliative treatment seems to be associated with eGFR degradation.