Assessing the value of ureteral stent placement in pediatric kidney transplant recipients.
BACKGROUND
Ureteral stent placement at kidney transplantation may reduce stenosis or leakage (S/L) complication rates. However, stent placement may also increase risk for early urinary tract infection (early UTI; <3 months after transplant) and BK virus allograft nephropathy (BKVAN). In children, the usefulness of stent placement is not well defined.


METHODS
We analyzed retrospective data from children transplanted at our center for the three above outcomes in relation to stents. At our center, stent placement decision is driven by surgeon preference.


RESULTS
Among 129 transplants from 1996 to 2006, early UTI was seen in 9.3% and S/L in 4.6%. By univariate analyses, stent placement was a significant risk factor for early UTI (P=0.0399) but not protective for S/L (P=0.23). In multivariate analyses, stent placement, human leukocyte antigen match, and bladder augmentation increased the odds ratio for early UTI. Only deceased donor source increased the odds ratio for S/L. In a truncated data set from 1999 to 2006, BKVAN occurred in 9 of 93 (9.6%). Per minute increase in warm ischemia time was the only significant risk factor for BKVAN by both univariate and Cox regression analyses. Stent placement did not improve graft survival (P=0.5726) but required general anesthesia for removal in the operating room, leading to additional cost and potential risk.


CONCLUSIONS
Routine stent placement in children in this era of low urological complication rates and BKVAN needs reevaluation.
Dharnidharka
Vikas R
VR
Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA. vikasmd@peds.ufl.edu
Araya
Carlos E
CE
Wadsworth
Christopher S
CS
McKinney
Michael C
MC
Howard
Richard J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods* / Q000502:physiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014019:Tissue Donors / Q000706:statistics & numerical data; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery
D006680:HLA Antigens