title: Prophylactic Ureteric Stents in Renal Transplant Recipients: A Multicenter Randomized Controlled Trial of Early Versus Late Removal.
abstract: Prophylactic ureteric stenting in renal transplantation reduces major urological complications; however, morbidity is related to the indwelling duration of a stent. We aimed to determine the optimal duration for stents in this clinical setting. Patients (aged 2-75 years) from six UK hospitals who were undergoing renal transplantation were recruited and randomly assigned to either early stent removal at 5 days (without cystoscopy) or late removal at 6 weeks after transplantation (with cystoscopy). The primary outcome was a composite of stent-related complications defined as pain, visible hematuria, migration, fragmentation, and urinary tract infections (UTIs) within 3 mo of transplantation. Between May 2010 and Nov 2013, we randomly assigned 227 participants, with 205 included in the final analysis of the primary outcome. Stent-related complications were significantly higher in the late versus early stent removal groups (36 of 126 [28.6%] vs. 6 of 79 [7.6%]; p < 0.001). The majority of stent complications consisted of UTIs, with an incidence of 31 of 126 (24.6%) in the late group compared with 6 of 79 (7.6%) in the early group (p = 0.004). We found early stent removal on day 5 significantly reduced stent-related complications and improved quality of life in the first 3 mo after transplantation (ISRCTN09184595).
authors.affiliation: Department of Nephrology, Transplantation and Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.affiliation: MRC Centre for Transplantation, King's College Hospital; Global Exploratory Development, UCB Biopharma, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: Rebollo-Mesa
authors.affiliation: Biostatistics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Ryan
authors.affiliation: Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Sinha
authors.affiliation: Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Marks
authors.affiliation: Department of Renal Transplantation, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Banga
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, UK.
authors.forename: I C
authors.initials: IC
authors.lastname: Macdougall
authors.affiliation: Department of Renal Medicine, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK.
authors.forename: M C
authors.initials: MC
authors.lastname: Webb
authors.affiliation: Department of Nephrology, Transplantation and Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Koffman
authors.affiliation: Department of Nephrology, Transplantation and Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Olsburgh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D066027:Transplant Recipients; D014513:Ureter / Q000601:surgery*; D014552:Urinary Tract Infections / Q000517:prevention & control; D055815:Young Adult
keywords: clinical research/practice; clinical trial; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; quality of life (QOL); surgical technique; urology