Percutaneous treatment of obstructive uropathy in renal transplant recipients: outcomes of nephrostomy tube placement within and after 30 days of transplantation

Abstract

Obstructive uropathy Ureteral anastomotic strictures Percutaneous nephrostomy Transplant ureteral strictures Renal transplant complications a b s t r a c t Purpose: To evaluate outcomes of percutaneous nephrostomies (PCN) in renal transplant recipients, and compare outcomes of PCN placement before and after 30 days from transplant. Material and methods: A retrospective audit of 1041 transplants undergoing PCN was performed. PCN population was classified into early-PCN and late-PCN groups (<30/>30 days from transplant). Graft survival (GS) was compared between early/late groups and transplants with and without PCN.Results: 79 (7.6%, n ¼ 79/1041) transplants underwent 89 PCN procedures. 67 (75%, n ¼ 67/89) underwent nephroureteral stent (NUS) placement and 12 (25%, n ¼ 12/89) were simple PCN placements. Procedure-related complications in early-vs. late-PCN were 4.3%, (n ¼ 1/23) and 3.0% (n ¼ 2/66) p > 0.05. Catheter-related complications in early-PCN vs. late-PCN were 13%, (n ¼ 3/23) and 11% (n ¼ 7/66) p > 0.05. Graft survival at 12, 36, and 48 months after PCN placement for early-PCN vs. late-PCN was 86% ± 7, 81 ± 8, and 81 ± 10 vs. 93% ± 3, 75 ± 8, and 66 ± 9, respectively (p ¼ 0.50). Graft survival at 1, 4, and 10 years after transplant in early-PCN vs. late-PCN was 86% ± 7, 86 ± 8, and 29% ± 17 vs. 96% ± 2, 81 ± 6, and 61 ± 13, respectively (p ¼ 0.01). Graft survival for all PCN vs. no-PCN transplants at 1, 4, and 10 years were 94% ± 3, 83% ± 5, and 55% ± 11 vs. 92% ± 1, 80% ± 1, and 59% ± 3, respectively (p ¼ 0.50).Conclusion: PCN in renal transplantation is safe and effective with no effect on graft survival. Early PCN poses no additional risk to the graft; however, it is a poor prognostic indicator for long-term graft survival.