title: Outcomes of Kidney Transplant Recipients With Percutaneous Ureteral Interventions: A Single-Center Study.
abstract: BACKGROUND
  Long-term outcomes of kidney transplantation recipients with percutaneous ureteral management of transplant ureteral complications are not well characterized.
  
  
  METHODS
  Electronic records of 1753 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. One hundred thirty-one patients were identified to have undergone percutaneous ureteral management, with placement of percutaneous nephrostomy tube or additional intervention (nephroureteral stenting and/or balloon dilation). Indications for intervention included transplant ureteral stricture or ureteral leak. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes.
  
  
  RESULTS
  Kaplan- Meier graft survival (P= 0.04) was lower in patients with percutaneous ureteral intervention for transplant ureteral complication. Graft survival at 1, 5, and 10 years was 94.3% 78.3%, and 59.1% for no intervention and 97.2%, 72.1%, and 36.2% for intervention cohort. Patient survival (P= 0.69) was similar between cohorts. Multivariate analysis demonstrated no association with graft failure (hazard ratio, 1.21; 95% confidence interval, 0.67-2.19;P= 0.53) or patient death (hazard ratio, 0.56; 95% confidence interval, 0.22-1.41;P= 0.22) in intervention group. The major cause of graft failure was infection for percutaneous ureteral intervention group (20.4%) and chronic rejection for those without intervention (17.3%).
  
  
  CONCLUSIONS
  Kidney transplant recipients with percutaneous ureteral interventions for ureteral complications do not have a significant difference in graft and patient survival outcomes. Therefore, aggressive nonoperative management can be confidently pursued in the appropriate clinical setting.
authors.affiliation: Department of Internal Medicine, Yale University, New Haven, CT.
authors.forename: Dushyanth
authors.initials: D
authors.lastname: Srinivasan
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: John T
authors.initials: JT
authors.lastname: Stoffel
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Chrystina
authors.initials: C
authors.lastname: James
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Kori
authors.initials: K
authors.lastname: Bradley
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Sung