Cayetano-Alcaraz Axel, Rodriguez-Alvarez Juan Sebastian, Vilatobá-Chapa Mario, Alberú-Gómez Josefina, Gabilondo-Pliego Bernardo, Rodríguez-Covarrubias Francisco, Morales-Buenrostro Luis Eduardo, Méndez-Probst Carlos Enrique
Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Transplants, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Can Urol Assoc J. 2019 Nov;13(11):E361-E365. doi: 10.5489/cuaj.5794.
Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients.
We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008-2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type.
From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36-4.37) and ureteral duplication (OR 3.29; 95% CI 2.40-4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96-11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors CONCLUSIONS:: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.
肾移植受者的输尿管狭窄（US）是一种罕见的并发症，可导致发病和移植肾丢失。识别危险因素对于预防和处理该疾病至关重要。既往研究提出，移植后第1周需要透析定义的延迟移植肾功能（DGF）是一个危险因素。我们的目的是确定DGF对肾移植患者发生US的影响。
我们设计了一项匹配病例对照研究。在2008年至2017年期间确定肾移植受者中的US病例。我们将US定义为血清肌酐升高，同时超声、闪烁扫描或逆行肾盂造影检查结果提示梗阻；排除移植肾功能障碍的任何其他原因。对照组定义为来自同一人群和时期且无US的肾移植受者，按年龄、性别和供体类型以1:2的比例进行匹配。
在532例肾移植患者中，纳入了31例病例和62例对照。US的累积发病率为每1000例58例。在计算比值比（OR）时，术后尿瘤（OR 3.2；95%置信区间[CI] 2.36 - 4.37）和输尿管重复（OR 3.29；95% CI 2.40 - 4.51）与US风险增加相关，而未发现DGF作为危险因素具有统计学意义（OR 3.3；95% CI 0.96 - 11.52）。在其他移植前和移植后相关因素方面，两组之间未发现统计学显著差异。结论：在我们的队列中，DGF与US无关；然而，输尿管重复和术后尿瘤与移植肾输尿管狭窄发生风险增加相关。
