Tyson Mark D, Castle Erik P, Andrews Paul E, Heilman Raymond L, Moss Adyr A, Mulligan David C, Reddy Kunam S
Department of Urology, Mayo Clinic, Phoenix, Arizona 85054, USA.
Can J Urol. 2012 Apr;19(2):6188-92.
To identify the incidence of and risk factors for ureteral stricture formation in laparoscopically procured living donor kidney transplantation (LLDKT).
An IRB approved retrospective review of our institution's living donor database was performed. Patients were divided into two cohorts, those with ureteral strictures requiring procedural intervention and those without evidence of ureteral strictures. Analysis was limited to those patients with at least 1 year of follow up.
Of the 584 LLDKT's performed at our institution since June 1999, 510 had at least 1 year of follow up. Four hundred and ninety-six patients had no evidence of stricture disease (97.2%) while 14 (2.8%) developed clinically significant ureteral strictures. The incidence of delayed graft function was higher in the stricture group (21% versus 3%, p < 0.0001) while the intraoperative placement of a ureteral stent was associated with decreased incidence of ureteral strictures (21% of the stricture group received stents compared to 58% in the no stricture group, p = 0.006). In multivariable logistic regression models, delayed graft function was strongly associated with the development of clinically significant ureteral stricture disease (OR 19.3; 95% CI 3.59, 104.2; p = 0.001) while the placement of intraoperative ureteral stents was protective against ureteral stricture formation (OR 0.09; 95% CI: 0.02, 0.49; p = 0.005).
Delayed graft function and nonuse of ureteral stents are associated with the development of ureteral strictures following LLDKT.
确定腹腔镜获取活体供肾移植（LLDKT）中输尿管狭窄形成的发生率及危险因素。
对本机构的活体供者数据库进行了一项经机构审查委员会批准的回顾性研究。患者被分为两组，一组为需要进行手术干预的输尿管狭窄患者，另一组为无输尿管狭窄证据的患者。分析仅限于那些至少随访1年的患者。
自1999年6月以来，在本机构进行的584例LLDKT中，510例至少随访了1年。496例患者无狭窄疾病证据（97.2%），而14例（2.8%）出现了具有临床意义的输尿管狭窄。狭窄组移植肾功能延迟的发生率更高（21%对3%，p<0.0001），而术中放置输尿管支架与输尿管狭窄发生率降低相关（狭窄组21%接受了支架，无狭窄组为58%，p = 0.006）。在多变量逻辑回归模型中，移植肾功能延迟与具有临床意义的输尿管狭窄疾病的发生密切相关（比值比19.3；95%可信区间3.59，104.2；p = 0.001），而术中放置输尿管支架可预防输尿管狭窄形成（比值比0.09；95%可信区间：0.02，0.49；p = 0.005）。
移植肾功能延迟和未使用输尿管支架与LLDKT术后输尿管狭窄的发生有关。
