No evidence for the need of a routine renal transplant ultrasound after elective transplant ureteric stent removal-A retrospective cohort study.
kidney transplantation
major urological complications
pediatric
post-stent removal graft ultrasonography
transplant ureteric stent
ultrasound
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
26
07
2019
revised:
19
12
2019
accepted:
06
03
2020
pubmed:
8
4
2020
medline:
10
8
2021
entrez:
8
4
2020
Statut:
ppublish
Résumé
Transplant ureteric stent insertion reduces the incidence of MUCs, but it is not known whether routine PSRGU is needed to detect unmasked MUCs. This study evaluated whether routine PSRGU in the pRTR is a useful tool to identify MUCs before they become clinically apparent. A retrospective analysis was undertaken of the clinical outcomes following elective stent removal from pediatric kidney-only transplant recipients at two London centers between 2012 and 2016. Our policy was to perform PSRGU either routinely or urgently if there were concerning symptoms or biochemical evidence of renal allograft dysfunction. Elective stent removal was performed in 86% (97 of 113 pRTR), and 75 (77%) of whom had routine PSRGU at a median (IQR) of 6 (2-8) days after stent removal. There were changes to management in 3 (4%) of pRTR with PSRGU identifying no MUC. Nineteen patients (25%) had urgent PSRGU, most commonly due to renal allograft dysfunction, at a median (IQR) of 5.5 (2.7-12.3) days after stent removal. Of these, two pRTR required ureteric intervention. For our current practice of removing transplant stents at 4-6 weeks post-transplantation, our study has found no evidence to support routine PSRGU after elective stent removal.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13704Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.11 Paediatrics (specific problems). Nephrol Dial Transplant. 2002;17(Suppl 4):55-58.
Chesnaye N, Bonthuis M, Schaefer F, et al. Demographics of paediatric renal replacement therapy in Europe: a report of the ESPN/ERA-EDTA registry. Pediatr Nephrol. 2014;29:2403-2410.
Plumb L, Wong E, Casula A, et al. Chapter 4 - Demography of the UK Paediatric Renal Replacement Therapy Population in 2016. Nephron. 2018;139(Suppl 1):105-116.
Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012;27:363-373.
Kaspar CDW, Bholah R, Bunchman TE. A review of pediatric chronic kidney disease. Blood Purif. 2016;41:211-217.
Dharnidharka VR, Agodoa L, Abbott KC. Effects of urinary tract infection on outcomes after renal transplantation in children. Clin J Am Soc Nephrol. 2007;2:100-106.
Saeed B. Pediatric renal transplantation. Int J Organ Transplant Med. 2012;3(2):62-73.
El Atat R, Derouiche A, Guellouz S, Gargah T, Lakhoua R, Chebil M. Surgical complications in pediatric and adolescent renal transplantation. Saudi J Kidney Dis Transpl. 2010;21:251-257.
Shoskes DA, Hanbury D, Cranston D, Morris PJ. Urological complications in 1,000 consecutive renal transplant recipients. J Urol. 1995;153(1):18-21.
Kumar A, Verma BS, Srivastava A, Bhandari M, Gupta A, Sharma R. Evaluation of the urological complications of living related renal transplantation at a single center during the last 10 years: impact of the Double-J stent. J Urol. 2000;164:657-660.
Rigg K, Proud G, Taylor RM. Urological complications following renal transplantation. Transpl Int. 1994;7:120-126.
Lapointe SP, Charbit M, Jan D. Urological complications after renal transplantation using ureteroureteral anastomosis in children. J Urol. 2001;166(3):1046-1048.
Nuininga JE, Feitz WF, van Dael KC, de Gier RP, Cornelissen EA. Urological complications in pediatric renal transplantation. Eur Urol. 2001;39(5):598-602.
Englesbe MJ, Lynch RJ, Heidt DG, et al. Early urologic complications after pediatric renal transplant: a single- center experience. Transplantation. 2008;86(11):1560-1564.
Maison P, Smit S, McCulloch M, et al. Urological complications following unstented pediatric renal Transplantation. Pediatr Transplant. 2017;21:e13045.
Dalgic A, Boyvat F, Karakayali H, Moray G, Emiroglu R, Haberal M. Urologic complications in 1523 renal transplantations: the baskent university experience. Transplantation Proc. 2006;38(2):543-547.
Visser I, Van Der Staaij JPT, Lafranca JA, Dor F. Timing of Double-J Stent removal and occurrence of urological complications: a systematic review and meta-analysis. Transplantation. 2018;102:S90.
Georgiev P, Böni C, Dahm F, et al. Routine stenting reduces urologic complications as compared with stenting "on demand" in adult kidney transplantation. Urology. 2007;70(5):893-897.
Mangus RS, Haag BW. Stented versus nonstented extravesical ureteroneocystostomy in renal transplantation: a metaanalysis. Am J Transplant. 2004;4(11):1889-1896.
Wilson CH, Bhatti AA, Rix DA, Manas DM. Routine intraoperative stenting for renal transplant recipients. Transplantation. 2005;80(7):877-882.
Thompson ER, Hosgood SA, Nicholson ML, Wilson CH. Early versus late ureteric stent removal after kidney transplantation. Cochrane Database Syst Rev. 2018;1:CD011455.
Tavakoli A, Surange RS, Pearson RC, Parrott NR, Augustine T, Riad HN. Impact of stents on urological complications and health care expenditure in renal transplant recipients: results of a prospective, randomized clinical trial. J Urol. 2007;177(6):2260-2264.
Akoh JA, Rana T. Effect of ureteric stents on urological infection and graft function following renal transplantation. World J Transplant. 2013;3:1-6.
Wilson CH, Rix DA, Manas DM. Routine intraoperative ureteric stenting for kidney transplant recipients. Cochrane Database Syst Rev. 2013;6:CD004925.
Das B, Hobday D, Olsburgh J, Callaghan C. The utility of routine ultrasound imaging after elective transplant ureteric stent removal. J Transplant. 2016;2016:1231567.
Patel P, Rebollo-Mesa I, Ryan E, et al. Prophylactic ureteric stents in renal transplant recipients: a multicenter randomized controlled trial of early versus late removal. Am J Transplant. 2017;17(8):2129-2138.
Lumbreras B, Donat L, Hernández-Aguado I. Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol. 2010;83(988):276-289.
Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010;7(10):754-773.
Hayward R. VOMIT (victims of modern imaging technology)-an acronym for our times. BMJ. 2003;326(7401):1273-1273.
Moynihan R, Glasziou P, Woloshin S, Schwartz L, Santa J, Godlee F. Winding back the harms of too much medicine. BMJ. 2013;346(7897):f1271.