Session: PD31: Renal Transplantation & Vascular Surgery II
PD31-03: Effectiveness of Endourological Management of Ureteral Stenosis in Kidney Transplant Patients: EAU-YAU Kidney Transplantation Working Group Collaboration.
Introduction: Ureteral stenosis (US) in kidney transplant (KT) recipients is associated with poorer long-term graft survival. Surgical repair is the standard of care, and endoscopic treatment may represent an alternative for stenosis <3 cm. We aimed to determine the effectiveness and safety of endourological management of US in KT patients and predictors of success. Methods: A retrospective multicenter study was conducted in four European referral centers, including all KT patients with US managed endoscopically between 2009 and 2021. Clinical success was defined as the absence of upper urinary tract catheterization, surgical repair or transplantectomy during follow-up. Results: A total of 44 patients were included. The median time to US onset was 3.5 months (IQR 1.9-10.8), the median length of stricture was 10 mm (IQR 7-20). Management of US involved balloon dilation and laser incision in 36 (82.5%) and 5 (13.2%) cases, respectively. Clavien-Dindo complications were infrequent (10%) and only one Clavien = III complication was reported. Clinical success was 61% at last follow-up visit (mean of 44.6% months). In the univariate analysis, sharp stenosis (vs. flat/concave) was associated with treatment success (RR 0.39, p 0.04), while late onset stenosis (>3 months post KT) with treatment failure (RR 2.00, p 0.02). Figure 1 shows two antegrade pyelograms of ureteral stenosis: A. Sharp or duckbill shape. B. Flat or concave shape. Conclusions: The success rate of the endoscopic management of ureteral stenosis in KT is 61%. Considering this technique is associated with a minimal level of complications, we conclude that in this setting an endoscopic treatment could be proposed first. Patients with a 10 mm sharp US diagnosed <3 months post KT are the best candidates. SOURCE OF Funding: None.
