Chordia P, Schain D, Kayler L
Department of Infectious Disease, Detroit Medical Center, Detroit, MI 48201, USA.
Transpl Infect Dis. 2013 Jun;15(3):268-75. doi: 10.1111/tid.12062. Epub 2013 Feb 20.
Placement of ureteral stents at the time of renal transplantation is thought to decrease the incidence of postoperative complications, such as anastomotic leakage and stenosis. However, stents may also predispose to post-transplantation urinary tract infection, which can lead to increased risks of graft dysfunction, sepsis, and death. The aim of this study was to analyze the risk of post-transplantation bacteriuria with ureteral stent placement in renal allograft recipients.
A retrospective single-center analysis was conducted to investigate the incidence of bacteriuria in all renal allograft recipients transplanted between January 2007 and March 2009. Recipients were categorized as in the nonstent group (NSTG) or the stent group (STG). Stent removal was performed per protocol at 6 weeks, and all patients were followed for at least 1 year post transplantation. In the NSTG, the incidence of bacteriuria was assessed at 0-6, 6-12, and 12 weeks to 1 year post transplantation. In the STG, bacteriuria was assessed prior to stent removal, 6 weeks after stent removal, and thereafter until 1 year post transplantation.
A total of 395 renal allograft recipients, 183 in the NSTG and 212 in the STG groups, were studied. The overall incidence of bacteriuria within 1 year post transplantation was similar between NSTG and STG (28.0 vs. 24.0%, P = 0.38). No difference was found in the incidence of bacteriuria when NSTG and STG were compared at 0-6 weeks or prior to stent removal (9.7% vs. 9.1%, P = 0.81), at 6-12 weeks, or 6 weeks after stent removal (6.7% vs. 5.8%, P = 0.75), and thereafter for 1 year post transplantation (13.3% vs. 10.8%, P = 0.46). The incidence of graft failure at 1 year was similar in NSTG and STG (6.2% vs. 4.9%, P = 0.6). Urinary anastomotic leakage occurred in none of the NSTG and 2 of the STG recipients. On multivariate analysis, risk factors for bacteriuria were female recipient gender (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.3, P = 0.001), delayed graft function (DGF) (OR 2.1, 95% CI 1.2-3.8, P = 0.01), and postoperative Foley catheterization for >5 days (OR 4.7, 95% CI 1.3-17.6, P = 0.02).
Independent risk factors for bacteriuria following kidney transplantation include DGF, prolonged postoperative Foley catheterization, and recipient female gender, but not placement of ureteral stents.
肾移植时放置输尿管支架被认为可降低术后并发症的发生率，如吻合口漏和狭窄。然而，支架也可能易引发移植后尿路感染，这会导致移植肾功能障碍、败血症和死亡风险增加。本研究的目的是分析肾移植受者放置输尿管支架后发生移植后菌尿的风险。
进行一项回顾性单中心分析，以调查2007年1月至2009年3月间所有肾移植受者的菌尿发生率。受者被分为无支架组（NSTG）或支架组（STG）。按照方案在6周时取出支架，所有患者移植后至少随访1年。在NSTG中，在移植后0至6周、6至12周以及12周后至1年评估菌尿发生率。在STG中，在取出支架前、取出支架后6周以及此后直至移植后1年评估菌尿情况。
共研究了395例肾移植受者，NSTG组183例，STG组212例。移植后1年内菌尿的总体发生率在NSTG组和STG组之间相似（28.0%对24.0%，P = 0.38）。当比较NSTG组和STG组在0至6周或取出支架前（9.7%对9.1%，P = 0.81）、6至12周或取出支架后6周（6.7%对5.8%，P = 0.75）以及此后移植后1年（13.3%对10.8%，P = 0.46）的菌尿发生率时，未发现差异。1年时移植失败的发生率在NSTG组和STG组中相似（6.2%对4.9%，P = 0.6）。NSTG组中无一例发生尿吻合口漏，STG组中有2例发生。多因素分析显示，菌尿的危险因素包括女性受者性别（比值比[OR] 2.5，95%置信区间[CI] 1.5 - 4.3，P = 0.001）、移植肾功能延迟恢复（DGF）（OR 2.1，95% CI 1.2 - 3.8，P = 0.01）以及术后留置Foley导尿管超过5天（OR 4.7，95% CI 1.3 - 17.6，P = 0.02）。
肾移植后菌尿的独立危险因素包括移植肾功能延迟恢复、术后长时间留置Foley导尿管以及受者为女性性别，而非输尿管支架的放置。
