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Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration

PURPOSE: 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 represents an alternative for stenosis < 3 cm. We aimed to determine the effectiveness and safety of endourolo...

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Autores principales: Territo, Angelo, Bravo-Balado, Alejandra, Andras, Iulia, Campi, Riccardo, Pecoraro, Alessio, Hevia, Vital, Prudhomme, Thomas, Baboudjian, Michael, Gallioli, Andrea, Verri, Paolo, Charbonnier, Mathieu, Boissier, Romain, Breda, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10352153/
https://www.ncbi.nlm.nih.gov/pubmed/37340277
http://dx.doi.org/10.1007/s00345-023-04455-3
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author Territo, Angelo
Bravo-Balado, Alejandra
Andras, Iulia
Campi, Riccardo
Pecoraro, Alessio
Hevia, Vital
Prudhomme, Thomas
Baboudjian, Michael
Gallioli, Andrea
Verri, Paolo
Charbonnier, Mathieu
Boissier, Romain
Breda, Alberto
author_facet Territo, Angelo
Bravo-Balado, Alejandra
Andras, Iulia
Campi, Riccardo
Pecoraro, Alessio
Hevia, Vital
Prudhomme, Thomas
Baboudjian, Michael
Gallioli, Andrea
Verri, Paolo
Charbonnier, Mathieu
Boissier, Romain
Breda, Alberto
author_sort Territo, Angelo
collection PubMed
description PURPOSE: 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 represents 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 failure. 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 34 (79.1%) and 6 (13.9%) cases, respectively, while 2 (4.7%) received both. Clavien–Dindo complications were infrequent (10%); only one Clavien ≥ III complication was reported. Clinical success was 61% at last follow-up visit (median = 44.6 months). In the bivariate analysis, duckbill-shaped stenosis (vs. flat/concave) was associated with treatment success (RR = 0.39, p = 0.04, 95% CI 0.12–0.76), while late-onset stenosis (> 3 months post KT) with treatment failure (RR = 2.00, p = 0.02, 95% CI 1.01–3.95). CONCLUSIONS: Considering the acceptable long-term results and the safety of these procedures, we believe that the endoscopic treatment should be offered as a first-line therapy for selected KT patients with US. Those with a short and duckbill-shaped stenosis diagnosed within 3 months of KT seem to be the best candidates.
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spelling pubmed-103521532023-07-19 Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration Territo, Angelo Bravo-Balado, Alejandra Andras, Iulia Campi, Riccardo Pecoraro, Alessio Hevia, Vital Prudhomme, Thomas Baboudjian, Michael Gallioli, Andrea Verri, Paolo Charbonnier, Mathieu Boissier, Romain Breda, Alberto World J Urol Original Article PURPOSE: 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 represents 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 failure. 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 34 (79.1%) and 6 (13.9%) cases, respectively, while 2 (4.7%) received both. Clavien–Dindo complications were infrequent (10%); only one Clavien ≥ III complication was reported. Clinical success was 61% at last follow-up visit (median = 44.6 months). In the bivariate analysis, duckbill-shaped stenosis (vs. flat/concave) was associated with treatment success (RR = 0.39, p = 0.04, 95% CI 0.12–0.76), while late-onset stenosis (> 3 months post KT) with treatment failure (RR = 2.00, p = 0.02, 95% CI 1.01–3.95). CONCLUSIONS: Considering the acceptable long-term results and the safety of these procedures, we believe that the endoscopic treatment should be offered as a first-line therapy for selected KT patients with US. Those with a short and duckbill-shaped stenosis diagnosed within 3 months of KT seem to be the best candidates. Springer Berlin Heidelberg 2023-06-20 2023 /pmc/articles/PMC10352153/ /pubmed/37340277 http://dx.doi.org/10.1007/s00345-023-04455-3 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Territo, Angelo
Bravo-Balado, Alejandra
Andras, Iulia
Campi, Riccardo
Pecoraro, Alessio
Hevia, Vital
Prudhomme, Thomas
Baboudjian, Michael
Gallioli, Andrea
Verri, Paolo
Charbonnier, Mathieu
Boissier, Romain
Breda, Alberto
Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration
title Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration
title_full Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration
title_fullStr Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration
title_full_unstemmed Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration
title_short Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration
title_sort effectiveness of endourological management of ureteral stenosis in kidney transplant patients: eau-yau kidney transplantation working group collaboration
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10352153/
https://www.ncbi.nlm.nih.gov/pubmed/37340277
http://dx.doi.org/10.1007/s00345-023-04455-3
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