Arabi Ziad, Al Thiab Khalefa, Altheaby Abdulrahman, Tawhari Mohammed, Aboalsamh Ghaleb, Almarastani Mohamad, Kashkoush Samy, Shaheen Mohammed F, Altamimi Abdulrahman, Alnajjar Lina, Alhussein Rawan, Almuhiteb Raghad, Alqahtani Bashayr, Alotaibi Rayana, Alqahtani Marah, Ghazwani Yahya, O'Hali Wael, Saad Khalid Bin
Division of Adult Transplant Nephrology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
J Transplant. 2021 Jul 2;2021:3428260. doi: 10.1155/2021/3428260. eCollection 2021.
To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent removal on urinary tract infections (UTIs) post renal transplantation.
A retrospective study was performed including all adult renal transplants who were transplanted between January 2017 and May 2020 with a minimum of 6-month follow-up at King Abdulaziz Medical City, Riyadh, Saudi Arabia.
A total of 279 kidney recipients included in the study were stratified into 114 in the early stent removal group (ESR) and 165 in the late stent removal group (LSR). Mean age was 43.4 ± 15.8; women: : 114, 40.90%; and deceased donor transplant: : 55, 19.70%. Mean stent removal time was 35.3 ± 28.0 days posttransplant (14.1 ± 4.6 days in the ESR versus 49.9 ± 28.1 days in LSR, < 0.001). Seventy-four UTIs were diagnosed while the stents were in vivo or up to two weeks after the stent removal "UTIs related to the stent" ( = 20, 17.5% in ESR versus = 54, 32.7% in LSR; =0.006). By six months after transplantation, there were 97 UTIs ( = 36, 31.6% UTIs in ESR versus = 61, 37% in LSR; =0.373). Compared with UTIs diagnosed after stent removal, UTIs diagnosed while the stent was still in vivo tended to be complicated (17.9% versus 4.9%, : 0.019), recurrent (66.1% versus 46.3%; : 0.063), associated with bacteremia (10.7% versus 0%; : 0.019), and requiring hospitalization (61% versus 24%, : 0.024). Early stent removal decreased the need for expedited stent removal due to UTI reasons (rate of UTIs before stent removal) ( = 11, 9% in the early group versus = 45, 27% in the late group; =0.001). The effect on the rate of multidrug-resistant organisms (MDRO) was less clear (33% versus 47%, : 0.205). Early stent removal was associated with a statistically significant reduction in the incidence of UTIs related to the stent (HR = 0.505, 95% CI: 0.302-0.844, =0.009) without increasing the incidence of urological complications. Removing the stent before 21 days posttransplantation decreased UTIs related to stent (aOR: 0.403, CI: 0.218-0.744). Removing the stent before 14 days may even further decrease the risk of UTIs (aOR: 0.311, CI: 0.035- 2.726).
Early ureteric stent removal defined as less than 21 days post renal transplantation reduced the incidence of UTIs related to stent without increasing the incidence of urological complications. UTIs occurring while the ureteric stent still in vivo were notably associated with bacteremia and hospitalization. A randomized trial will be required to further determine the best timing for stent removal.
评估肾移植术后早期（<3周）与晚期（>3周）拔除输尿管支架对尿路感染（UTI）的影响。
进行一项回顾性研究，纳入2017年1月至2020年5月在沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城接受肾移植的所有成年患者，且至少随访6个月。
本研究共纳入279例肾移植受者，分为早期支架拔除组（ESR）114例和晚期支架拔除组（LSR）165例。平均年龄为43.4±15.8岁；女性114例（40.90%）；尸体供肾移植55例（19.70%）。平均支架拔除时间为移植后35.3±28.0天（ESR组为14.1±4.6天，LSR组为49.9±28.1天，P<0.001）。在支架留置期间或拔除后两周内诊断出74例UTI（“与支架相关的UTI”）（ESR组20例，占17.5%；LSR组54例，占32.7%；P=0.006）。移植后6个月时，共有97例UTI（ESR组36例，占31.6%；LSR组61例，占37%；P=0.373）。与支架拔除后诊断出的UTI相比，支架仍留置时诊断出的UTI往往更复杂（17.9%对4.9%，P=0.019）、复发率更高（66.1%对46.3%；P=0.063）、与菌血症相关（10.7%对0%；P=0.019）且需要住院治疗（61%对24%，P=0.024）。早期拔除支架降低了因UTI原因而加急拔除支架的需求（支架拔除前的UTI发生率）（早期组11例，占9%；晚期组45例，占27%；P=0.001）。对多重耐药菌（MDRO）发生率的影响不太明确（33%对47%，P=0.205）。早期拔除支架与与支架相关的UTI发生率在统计学上显著降低相关（HR=0.505，95%CI：0.302-0.844，P=0.009），且未增加泌尿系统并发症的发生率。移植后21天内拔除支架可降低与支架相关的UTI（校正后比值比：0.403，CI：0.218-0.744）。在14天前拔除支架甚至可能进一步降低UTI风险（校正后比值比：0.311，CI：0.035-2.726）。
肾移植术后21天内拔除输尿管支架可降低与支架相关的UTI发生率，且不增加泌尿系统并发症的发生率。输尿管支架仍留置时发生的UTI与菌血症和住院显著相关。需要进行一项随机试验以进一步确定支架拔除的最佳时机。
