Klinisch I - P14 - Which way to stent the ureter? Comparison of 2 ways of urinary drainage in pediatric kidney transplantation

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A.S. ter Haar, R.S. Parekh, R.W.J. Leunissen, J. van den Hoek, A. Lorenzo, D. Hebert, M.G. Keijzer-Veen, K. Cransberg

Chair(s): prof. dr. Jaap Homan van der Heide, nefroloog, AMC

Thursday 10 march 2016

13:30 - 14:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

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Purpose:
Ureteral stenting in kidney transplantation serves to limit the development of obstruction and urinary leakage, but forms a source of complications as well. A JJ catheter is most frequently used as ureteral stent. External stenting (pyelovesicostomy or splint) on the other hand allows separate analysis of the urine from the transplanted kidney, and avoids a reoperation to remove the JJ catheter. In this study we compared the complication rate of external stenting with that of a JJ catheter in pediatric renal transplant recipients.

Methods:
Children who received a kidney transplant at Erasmus MC Sophia, Rotterdam between 2006 and 2014 were compared to children transplanted at The Hospital for Sick Children, Toronto, Canada between 2010 and 2014. Patients in Rotterdam received a splint for initial urinary drainage (splint group), and in Toronto a JJ stent (JJ group). Surgical procedures and immunosuppressive therapy were similar. Outcome measures included the need of additional urological interventions and the incidence of urinary tract infections (UTI) during 3 months after transplantation.The data were retrospectively collected.

Results:
The splint group (n=62) and the JJ group (n=50) did not differ significantly in age, sex, primary diagnosis, method of ureteral implantation, but differed in donor source (LD 55% vs. 36% respectively), and induction therapy (ATG or basiliximab in JJ group, only basiliximab in splint group). The splint was removed after a median of 9 days (IQR 8-12), the JJ catheter after 42 days (IQR 38-50). In the splint group 7 (11.3%) children needed 9 urological reinterventions (6 a JJ catheter and 3 a percutaneous nephrostomy), in the JJ group 2 (1 renewal of JJ catheter, and 1 a percutaneous nephrostomy (log rank p 0.157)). In the splint group 20 children (32%) developed 28 UTIs, 9 during presence of the external drain; in the JJ group 25 children (50%, p 0.057) had 66 UTI (p 0.024), 42 during presence of the JJ catheter (p 0.001).

Conclusion:
Children with a JJ stent developed more UTIs than children with a splint, however, there was a, not significantly, larger number requiring reinterventions in the splint group. Both options for urinary drainage have complications suggesting the need for modification of current methods.