Wingate Jonathan T, Brandenberger Jared, Weiss Andrew, Scovel Lauren G, Kuhr Christian S
Department of Urology, Madigan Army Medical Center, Tacoma, WA, USA.
Department of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA.
Transpl Infect Dis. 2017 Feb;19(1). doi: 10.1111/tid.12644. Epub 2017 Jan 27.
Ureteral stents are used in kidney transplantation (KTX) to decrease post-operative complications, but they are associated with BK polyomavirus viremia (BKV). Our primary outcome was to determine the association between ureteral stent duration and BKV. Secondary outcome measures were the association between bacteriuria and stent duration or use of ureteral stent strings.
Between January 2010 and January 2015, 403 patients underwent KTX at the Virginia Mason Medical Center and met inclusion criteria. Stent duration was classified as short (<3 weeks) or long (>3 weeks). Multivariate logistic regression models were created to assess for factors associated with BKV. The covariates in the BKV model were chosen a priori based on stent duration and risk factors previously described in the literature.
Ureteral stents were placed in 304 (75.4%) transplants. Stent strings were left attached in 166 (54.6%) patients. On multivariate analyses, long stent duration was significantly associated with increased risk of BKV compared with no stent (odds ratio [OR] 1.92, P=.044, 95% confidence interval [CI] 1.04-3.74). Short stent duration was not associated with BKV. Sixty-two (15.4%) patients had bacteriuria. Bacteriuria was associated with female gender (OR 2.77, P<.001, 95% CI 1.58-4.95), and there was a dose-dependent effect with stent duration compared with no stent-short duration (OR 2.46, P=.049, 95% CI 1.05-6.49) and long duration (OR 3.58, P=.004, 95% CI 1.58-9.25). Stent strings were not associated with either complication.
The association between ureteral stents and BKV may be dose dependent.
输尿管支架用于肾移植（KTX）以减少术后并发症，但它们与BK多瘤病毒血症（BKV）相关。我们的主要结果是确定输尿管支架留置时间与BKV之间的关联。次要结果指标是菌尿与支架留置时间或输尿管支架线使用之间的关联。
2010年1月至2015年1月期间，403例患者在弗吉尼亚梅森医疗中心接受了KTX并符合纳入标准。支架留置时间分为短（<3周）或长（>3周）。创建多变量逻辑回归模型以评估与BKV相关的因素。BKV模型中的协变量根据支架留置时间和先前文献中描述的危险因素预先选择。
304例（75.4%）移植手术中放置了输尿管支架。166例（54.6%）患者留置了支架线。在多变量分析中，与未放置支架相比，长支架留置时间与BKV风险增加显著相关（优势比[OR]1.92，P = 0.044，95%置信区间[CI]1.04 - 3.74）。短支架留置时间与BKV无关。62例（15.4%）患者发生菌尿。菌尿与女性性别相关（OR 2.77，P < 0.001，95% CI 1.58 - 4.95），与未放置支架相比，支架留置时间存在剂量依赖性效应——短时间（OR 2.46，P = 0.049，95% CI 1.05 - 6.49）和长时间（OR 3.58，P = 0.004，95% CI 1.58 - 9.25）。支架线与任何一种并发症均无关。
输尿管支架与BKV之间的关联可能是剂量依赖性的。
