title: Ureteral stents are associated with reduced risk of ureteral complications after kidney transplantation:  a large single center experience.
abstract: BACKGROUND
  Controversy exists regarding the benefit of ureteral stents in kidney transplantation. We aimed to examine the association of stents with risk of ureteral complications, particularly in relationship with donor type.
  
  
  METHODS
  Kidney transplants from 2005 to 2009 were evaluated (n=1224). Patients with previous or simultaneous nonkidney transplants, death, or lost to follow-up within 90 days were excluded, unless already developed a ureteral complication. Only cases with a single extravesical ureteroneocystostomy were included. The cohort (n=961) was divided into stent (32.2%) and no-stent (67.7%) groups. Poisson regression was used to examine the association of stent with ureteral complications (leak or stricture) and urinary tract infections (UTI).
  
  
  RESULTS
  Ureteral complication rate was 1.9% in stent versus 5.8% in no-stent group (P=0.007). UTI rate was 14.2% with stent versus 7.9% without stent (P=0.003). Stent use was independently associated with reduction in ureteral complications (incidence rate ratios [IRR], 0.40; P=0.04; 95% confidence interval [CI], 0.17-0.96) and an increase in UTI risk (IRR, 1.79; P=0.006; 95% CI, 1.18-2.74). Stent protective effect was primarily related to reduction in stricture risk (IRR, 0.23; P<0.05; 95% CI, 0.05-0.99). Stents were associated with a decrease in ureteral complications in deceased donor recipients (IRR, 0.34; P=0.03; 95% CI, 0.13-0.88), but not living donors (IRR, 1.24; P=0.84; 95% CI, 0.15-10.2).
  
  
  CONCLUSIONS
  Ureteral stents are associated with a significant reduction in ureteral complications but increases UTI risk. Routine stenting in deceased donor transplants is recommended as its protective effect was observed in this group. The value of stents in living donor transplants warrants further investigation.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. sfayek@smail.umaryland.edu
authors.forename: Sameh A
authors.initials: SA
authors.lastname: Fayek
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Keenan
authors.forename: Abdolreza
authors.initials: A
authors.lastname: Haririan
authors.forename: Matthew
authors.initials: M
authors.lastname: Cooper
authors.forename: Rolf N
authors.initials: RN
authors.lastname: Barth
authors.forename: Eugene
authors.initials: E
authors.lastname: Schweitzer
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Bromberg
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Bartlett
authors.forename: Benjamin
authors.initials: B
authors.lastname: Philosophe
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012306:Risk; D015607:Stents; D014515:Ureteral Diseases / Q000453:epidemiology / Q000517:prevention & control*; D014517:Ureteral Obstruction / Q000453:epidemiology / Q000517:prevention & control; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*