Ureteral Stent Placement Increases the Risk for Developing BK Viremia after Kidney Transplantation

Abstract

The placement of ureteral stent (UrSt) at kidney transplantation reduces major urological complications but increases the risk for developing nephropathy from the BK virus. It is unclear whether UrSt placement increases nephropathy risk by increasing risk of precursor viral replication or by other mechanisms. We retrospectively investigated whether UrSt placement increased the risk for developing BK Viremia (BKVM) in adult and pediatric kidney transplants performed at the University of Florida between July 1, 2007, and December 31, 2010. In this period all recipients underwent prospective BKV PCR monitoring and were maintained on similar immunosuppression. Stent placement or not was based on surgeon preference. In 621 transplants, UrSt were placed in 295 (47.5%). BKVM was seen in 22% versus 16% without UrSt (P = 0.05). In multivariate analyses, adjusting for multiple transplant covariates, only UrSt placement remained significantly associated with BKVM (P = 0.04). UrSt placement significantly increased the risk for BKVM. Routine UrSt placement needs to be revaluated, since benefits may be negated by the need for more BK PCR testing and potential for graft survival-affecting nephritis.

Ureteral stent placement and immediate graft function are associated with increased risk of BK viremia in the first year after kidney transplantation

“…In addition, multivariate analysis revealed that immediate graft function is associated with increased rate of BK viremia. These findings support results from previous studies performed on smaller populations and affirm the need for greater vigilance for BK‐related kidney disease post‐transplant in patients receiving ureteral stent placement.…”

“…The study by Hashim et al . in 2014, which included one of the present study authors but at a separate center, used a retrospective study design with a larger study population of 621 patients and reported an increased adjusted risk of both BK viruria (adjusted OR, 1.67; P = 0.04) and BK viremia (adjusted OR, 1.55; P = 0.04).…”

BK virus nephropathy in renal transplant recipients

“…In a single centre retrospective study, comparing 295 RTR who had ureteric stents placed was compared with 326 without stent as per the surgeon's preference. BK viremia was seen in 22% in those with stent versus 16% without stent ( P = 0.05) . However, ureteric stent is the current standard practice as it reduces immediate post‐transplant urologic complications.…”

Urologic Considerations and Complications in Kidney Transplant Recipients

“…53 Additionally, literature suggests that ureteral stenting during kidney transplant increases the risk of polyomavirus BK viremia and viruria. 54 OTHER UROLOGIC CONSIDERATIONS IN THE KIDNEY TRANSPLANT RECIPIENT UTI in transplant recipients is established with urine culture and treated with antibiotic therapy. Pyelonephritis can present with fever and systemic symptoms, such as abdominal pain, pain over the graft site, nausea, and emesis, and presents harm to the graft through renal parenchymal scarring.…”